CAM 步行靴与硬底鞋治疗第五跖骨近段 1 区骨折的比较。

Treatment of Zone 1 Fractures of the Proximal Fifth Metatarsal With CAM-Walker Boot vs Hard-Soled Shoes.

机构信息

Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), São Paulo, SP, Brazil.

Department of Orthopaedics, Clínica de Ortopedia Ortocity, São Paulo, SP, Brazil.

出版信息

Foot Ankle Int. 2020 May;41(5):508-512. doi: 10.1177/1071100720903259. Epub 2020 Feb 5.

DOI:10.1177/1071100720903259

PMID:32020818

Abstract

BACKGROUND

Zone 1 fractures of the proximal fifth metatarsal are usually treated nonsurgically using some type of immobilization. The aim of this study was to compare clinical and functional outcomes, time to return to prior activity levels, and rate of bone healing when using a hard-soled shoe (HSS) vs a controlled ankle motion (CAM)-walker boot (CWB).

METHODS

Seventy-two consecutive patients with zone 1 fractures of the fifth metatarsal base were treated conservatively with either an HSS or CWB by 2 different providers. We included 57 women and 15 men, average age of 41.3 (range, 16-88) years. Radiographic findings, visual analog scale (VAS) for pain, and American Orthopaedic Ankle & Foot Society (AOFAS) midfoot score were assessed. Patients were followed at 4, 8, 10, 12, and 24 weeks or until asymptomatic and able to return to prior level of activities. Statistical analysis was performed using Mann-Whitney , Fisher exact, and chi-square tests. values <.05 were considered significant.

RESULTS

Age and gender distributions were similar in both groups ( = .23 and = .57). Patients had similar VAS and AOFAS scores after 8 ( = .34 and = .83) and 12 ( = .87 and = .79) weeks. Average time for bone healing was significantly faster using the CWB (7.2 weeks) when compared to the HSS (8.6 weeks) ( < .001). The average time to return to prior level of activities was similar in both groups (8.3 weeks for CWB and 9.7 weeks for HSS) ( = .11). Fracture displacement was equal in both groups, with a mean of 1.9 mm of displacement in patients using the HSS, and a mean of 1.6 mm in those using the CWB ( = .26).

CONCLUSION

Zone 1 fractures of the proximal fifth metatarsal can be treated conservatively with either a hard-soled shoe or a CAM-walker boot. Even though patients treated in the CAM-walker boot demonstrated earlier signs of complete healing, similar clinical and functional results were achieved with both treatments.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.

摘要

背景

第五跖骨近端 1 区骨折通常采用某种类型的固定方式进行非手术治疗。本研究的目的是比较使用硬底鞋（HSS）与控制踝关节运动（CAM）步行靴（CWB）治疗第五跖骨基底 1 区骨折的临床和功能结果、恢复至先前活动水平的时间以及骨愈合率。

方法

72 例第五跖骨基底 1 区骨折患者由 2 位不同的医生分别采用 HSS 或 CWB 进行保守治疗。纳入 57 名女性和 15 名男性，平均年龄 41.3（16-88）岁。评估影像学发现、疼痛视觉模拟量表（VAS）和美国矫形足踝协会（AOFAS）中足评分。患者在第 4、8、10、12 和 24 周或直至无症状且能够恢复至先前活动水平时进行随访。采用 Mann-Whitney、Fisher 确切检验和卡方检验进行统计学分析。值＜.05 被认为具有统计学意义。

结果

两组的年龄和性别分布相似（ =.23 和 =.57）。8 周时两组的 VAS 和 AOFAS 评分相似（ =.34 和 =.83），12 周时相似（ =.87 和 =.79）。与 HSS 相比，CWB 组的骨愈合时间明显更快（分别为 7.2 周和 8.6 周）（ <.001）。两组恢复至先前活动水平的平均时间相似（CWB 组为 8.3 周，HSS 组为 9.7 周）（ =.11）。两组的骨折移位程度相同，HSS 组的平均移位为 1.9mm，CWB 组的平均移位为 1.6mm（ =.26）。