Sangeorzan B J, Mayo K A, Hansen S T
University of Washington Department of Orthopaedic Surgery, Seattle 98104.
Clin Orthop Relat Res. 1993 Jul(292):135-41.
In the absence of historical comparative data for the treatment of tarsal fractures, commonly abided maxims of trauma care are noteworthy. A displaced fracture involving an articular surface or a fracture interrupting a mechanical axis is treated by open reduction and internal fixation. Rigid fixation is followed as early as possible with active and passive mobilization. Unlike long bones, whose motion and fracture patterns (i.e., segmental, transverse, and oblique) are understood, the tarsal bones are small bones with complex shapes and restricted motion. As a result, tarsal injuries most often occur with multiple ligamentous and bony injuries. Articular step-off is difficult to establish roentgenographically, the blood supply is tenuous, and fixation is largely dependent on screws and Kirschner wires. Good outcome can be obtained by following principles of internal fixation established in treatment of major joint injuries.
由于缺乏跗骨骨折治疗的历史比较数据，创伤护理中普遍遵循的准则值得关注。涉及关节面的移位骨折或中断机械轴的骨折需通过切开复位内固定治疗。尽早进行牢固固定并积极主动和被动活动。与长骨不同，长骨的运动和骨折模式（即节段性、横向和斜向）已为人所知，跗骨是形状复杂且活动受限的小骨。因此，跗骨损伤常伴有多处韧带和骨损伤。关节台阶在X线片上难以确定，血供薄弱，固定很大程度上依赖螺钉和克氏针。遵循主要关节损伤治疗中确立的内固定原则可获得良好疗效。
