Coulibaly Marlon O, Jones Clifford B, Sietsema Debra L, Schildhauer Thomas A
Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, United States; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States.
Injury. 2015 Aug;46(8):1669-77. doi: 10.1016/j.injury.2015.04.033. Epub 2015 May 7.
Navicular fractures (NF) are uncommon. The purpose of this study was to compare results of operative (ORIF) and non-operative (NOT) treatment in NF.
A retrospective analysis was undertaken on patients diagnosed with NF between March 2002 and June 2007 at a Level I teaching trauma centre. Clinical outcome consisted of functional ability and complications.
Eighty-eight patients with 90 fractures were identified including 56 males and 32 females with a mean age of 38 (range 17-72) and body mass index of 28.2 (range 18.7-48.9). Twenty-one of 90 (23.3%) injuries were isolated. Ten of 90 (11.1%) injuries were open. Treatment was 49/90 (55%) NOT and 41/90 (45.6%) ORIF. 11/41 (30%) ORIF required bone grafting. Complications included one ipsilateral deep vein thrombosis, one avascular necrosis, one nonunion, seven infections (two deep and five superficial), and 56 cases of secondary osteoarthrosis (SOA). ORIF had significantly more SOA (χ(2)=0.000). Secondary surgery was 25 hardware removals (16 for irritation, five for prominent or broken plates), nine arthrodeses/-plasties, two debridements for infection, and one tarsal tunnel release. Pain was present at final follow up in 39/90 (43.3%) feet. Work status was 64 without restrictions, 17 with restrictions, and 5 did not return to work. Sixty-two of 88 (69%) patients were able to wear normal shoes, which were related to return to work without restrictions (ρ=-0.508, p=0.000). Inability to return to previous work was related to pain (ρ=-0.394), SOA (ρ=-0.280), and poor reduction quality (ρ=-0.384) with significance at p<0.01. Increased BMI (>35) related to pain (ρ=0.250) and poor reduction quality (ρ=0.326) at a σ<0.05.
Despite modern surgical techniques, operative treatment of displaced fractures is at high risk for complications. Obesity, pain, and secondary osteoarthrosis determine shoe wear, return to function, and employment status.
Level III.
舟骨骨折（NF）并不常见。本研究的目的是比较舟骨骨折的手术治疗（切开复位内固定术，ORIF）和非手术治疗（NOT）的效果。
对2002年3月至2007年6月在一级教学创伤中心诊断为舟骨骨折的患者进行回顾性分析。临床结果包括功能能力和并发症。
共纳入88例患者的90处骨折，其中男性56例，女性32例，平均年龄38岁（范围17 - 72岁），体重指数28.2（范围18.7 - 48.9）。90处损伤中有21处（23.3%）为单纯性骨折。90处损伤中有10处（11.1%）为开放性骨折。治疗方式为非手术治疗49/90（55%），切开复位内固定术41/90（45.6%）。41例切开复位内固定术中11例（30%）需要植骨。并发症包括1例同侧深静脉血栓形成、1例缺血性坏死、1例骨不连、7例感染（2例深部感染和5例浅表感染）以及56例继发性骨关节炎（SOA）。切开复位内固定术组的继发性骨关节炎明显更多（χ(2)=0.000）。二次手术包括25例取出内固定物（16例因刺激、5例因钢板突出或断裂）、9例关节融合术/成形术、2例因感染进行的清创术以及1例跗管松解术。末次随访时，90只足中有39只（43.3%）存在疼痛。工作状态为64例无限制，17例有限制，5例未恢复工作。88例患者中有62例（69%）能够穿正常鞋子，这与无限制恢复工作相关（ρ=-0.508，p=0.000）。无法恢复既往工作与疼痛（ρ=-0.394）、继发性骨关节炎（ρ=-0.280）以及复位质量差（ρ=-0.384）有关，p<0.01时有统计学意义。体重指数增加（>35）与疼痛（ρ=0.250）和复位质量差（ρ=0.326）相关，σ<0.05。
尽管有现代手术技术，但移位骨折的手术治疗并发症风险仍很高。肥胖、疼痛和继发性骨关节炎决定了鞋类穿着、功能恢复和就业状况。
三级。
