摘要
背景：足舟骨骨折在临床上越来越常见,如果处理不当,极易影响患者负重行走以及行走步态。早期正确诊断和及时恰当的治疗对于防止足部并发症的发生极其重要。目的：探讨足舟骨骨折的手术治疗方法及疗效。方法：回顾性分析2002年7月至2012年3月,手术治疗且获得完整随访的90例（90足）足舟骨骨折患者的病例资料。男62例,女28例;年龄17~62岁,平均31.6岁;左足46例,右足44例。受伤原因：高处坠落伤38例,交通事故26例,扭伤18例,重物砸伤8例。入院后拍摄标准的足正、侧、斜位X线片及CT扫描。按照骨折部位分类：足舟骨背侧撕脱骨折6例,足舟骨结节撕脱骨折18例,足舟骨体部骨折66例。66例足舟骨体部骨折按照Sangeorzan骨折分型：Ⅰ型4例,Ⅱ型44例,Ⅲ型18例。受伤至手术时间为1~16 d,平均6.75 d。90例患者根据不同的骨折类型选择可吸收螺钉、空心螺钉、克氏针、钛板及外固定架固定手术治疗。术后定期复查拍摄X线片及CT扫描明确骨折愈合情况,记录足踝部功能恢复情况及相关并发症,按照美国足与踝关节协会（AOFAS）踝与中足评分标准评定治疗效果。结果：90例患者随访15~103个月,平均45.6个月。骨折愈合时间10~15周,平均12.1周。末次随访时AOFAS踝与中足评分平均为87.3分。4例患者出现螺钉断裂,但均未发生复位丢失。12例患者出现创伤性骨关节炎,后期随访未进行关节融合术。4例患者发生足舟骨缺血坏死,其中3例为足舟骨部分缺血坏死,发生距舟关节骨关节炎,行距舟关节及舟楔关节融合术;1例于术后5个月出现足舟骨全部坏死,继发扁平足,行三关节融合术。结论：不同类型的足舟骨骨折,选择合适的手术固定方式治疗可以取得良好的疗效。
Background： Tarsal navicular fractures are increasingly common in clinic. If these fractures are mishandled, it will be very likely to influence patients＇ gaits and weight- bearing walking. Thus early accurate diagnosis and appropriate treatment in time are of vital importance in the prevention of complications.Objective： To investigate surgical treatments of tarsal navicular fractures and its effectiveness.Methods： A retrospective study was undertaken in 90 tarsal navicular fractures patients（90 feet） treated surgically between July 2002 and March 2012. Their complete data of follow- up were obtained. There were 62 males and 28 females with a mean age of 31.6 years（range, 17-62 years）. The left feet were involved in 46 cases and the right feet was in 44 cases. Injuries were caused by falling from height in 38 cases, by traffic accident in 26 cases, by sprain in 18 cases, and by heavy pound in 8 cases. X-ray and three-dimensional CT scanning were performed when the patients were admitted to our hospital. There were 6 patients with dorsal avulsion fractures, 18 with tuberosity avulsion fracture, and 66 with body fractures.The body fractures were further classified according to the Sangeorzan system： type Ⅰ in 4 cases, type Ⅱ in 44 cases and type Ⅲ in 18 cases. The mean duration from injury to surgery was 6.75 d（range, 1-16 d）. Different surgical treatments were selected for different types of 90 tarsal navicular fractures. Bone union was evaluated by X-ray and complications were recorded. Final outcome was evaluated by the Ankle and Midfoot score system of American Orthopacdic Foot and Ankle Society（AOFAS）.Results： All the patients were followed up for 45.6 months on average（range, 15- 103 months）. The mean time of bone union was 12.1 weeks（range, 10-15 weeks）. The mean AOFAS score was 87.3 at the last follow-up. Screws broke in 4 patients, but no reduction was lost. The traumatic osteoarthritis occurred in 12 patients and no further treatment, for example,arthrodesis was
出处
《中国骨与关节外科》
2015年第4期304-309,共6页
Chinese Journal of Bone and Joint Surgery
基金
河北省科技厅支撑项目(项目编号:JB00 11276103D-15)
关键词
足舟骨
骨折
固定
治疗
Navicular
Fracture
Fixation
Treatment
