[新鲜闭合性跗中关节骨折脱位的治疗]

Du Xiaojian, Qu Jiafu, Cao Lihai, Zhao Guozhi, Yan Rongliang, Wu Jun, Peng Yi, Wang Liang

Department of Foot and Ankle Surgery, Second Hospital of Tangshan, Affiliated Orthopaedic Hospital of Hebei Union University, Tangshan Hebei 063000, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Oct;26(10):1178-81.

OBJECTIVE

To investigate the treatment method and effectiveness of fresh closed fracture-dislocation of the midtarsal joint.

METHODS

Between April 2004 and April 2011, 73 patients (75 feet) with fresh closed fracture-dislocation of the midtarsal joint were treated with closed reduction combined with open reduction and internal fixation. There were 56 males (58 feet) and 17 females (17 feet), aged from 19 to 62 years (mean, 35.8 years). Injuries were caused by falling from height in 35 cases, by sprain in 4 cases, by machine twist in 5 cases, by heavy pound in 9 cases, and by traffic accident in 20 cases. The time from injury to admission ranged from 1 hour and 30 minutes to 48 hours (mean, 4.5 hours). According to Main's classification standard, 6 feet were rated as vertical compression injury, 33 feet as medial displacement injury, 17 feet as lateral displacement injury, 9 feet as flexion injury, and 10 feet as crush injury. Concomitant injuries included midfoot fracture-dislocation (34 feet), scaphoid fracture (6 feet), cuboid bone fracture (18 feet), calcaneal fracture (8 feet), talus fracture (7 feet), tibiotalar joint dislocation (2 feet), subtalar joint dislocation (2 feet), medial malleolus fracture (1 foot), and acute compartment syndrome (3 feet).

RESULTS

Healing of incision by first intention was achieved in 65 cases (67 feet), by second intention in 8 cases (8 feet). Sixty-two cases (62 feet) were followed up from 11 months to 7 years and 11 months (mean, 3 years and 6 months). After operation, feet pain occurred in 26 cases, and stiffness or discomfort of the affected foot in 36 feet when walking. The X-ray examination showed good reduction of fracture-dislocation of the midtarsal joint and concomitant injuries with no re-dislocation or bone nonunion in 59 feet; 3 feet had flatfoot secondary to navicular necrosis, and underwent arthrodesis. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 77-90 (mean, 88.6) at last follow-up.

CONCLUSION

According to the preoperative evaluation of the damage, using the manual reduction combined with internal fixation (mini-plate or hollow screw with Kirschner wire) methods can obtain good effectiveness in the treatment of fracture-dislocation of the midtarsal joint.

目的

探讨新鲜闭合性跗中关节骨折脱位的治疗方法及疗效。

方法

2004年4月至2011年4月，对73例（75足）新鲜闭合性跗中关节骨折脱位患者采用闭合复位联合切开复位内固定治疗。其中男性56例（58足），女性17例（17足），年龄19～62岁，平均35.8岁。致伤原因：高处坠落35例，扭伤4例，机器绞伤5例，重物砸伤9例，交通事故20例。伤后至入院时间为1小时30分至48小时，平均4.5小时。按Main分类标准，垂直压缩伤6足，内侧移位伤33足，外侧移位伤17足，屈曲伤9足，挤压伤10足。合并伤包括中足骨折脱位34足，舟骨骨折6足，骰骨骨折18足，跟骨骨折8足，距骨骨折7足，胫距关节脱位2足，距下关节脱位2足，内踝骨折1足，急性骨筋膜室综合征3足。

结果

65例（67足）切口一期愈合，8例（8足）二期愈合。62例（62足）获随访，时间11个月至7年11个月，平均3年6个月。术后足部疼痛26例，行走时患足僵硬或不适36足。X线检查示跗中关节骨折脱位及合并伤复位良好，59足无再脱位及骨不连；3足因舟骨坏死继发扁平足，行关节融合术。末次随访时美国矫形足踝协会（AOFAS）评分77～90分，平均88.6分。