摘要
背景:开放性中足骨折脱位损伤的致残率高,治疗难度大,分期手术治疗为其提供了新的思路。目的:探讨开放性中足骨折脱位损伤分期手术治疗的方法及疗效。方法:回顾性分析2013年8月至2018年5月采用分期手术治疗的开放性中足骨折脱位损伤的10例患者。其中一期行急诊彻底清创,修复创面,对骨折脱位进行复位及简单固定;二期根据软组织修复和中足各骨与关节复位固定情况,个体化选择手术时机及内固定方式。术后观察骨折愈合及并发症发生情况,末次随访采用美国足踝外科协会(AOFAS)中足评分评价足部功能。结果:所有患者均获得随访,随访时间11~23个月,平均(14.5±3.8)个月。骨性愈合时间11~17周,平均(14.2±2.3)周。未见深部感染、骨髓炎、骨不连及内固定物失效等并发症。1例患者二期内固定术后13个月发生严重创伤性关节炎,再次行关节融合,症状明显缓解。末次随访时AOFAS中足评分平均为(84.3±13.6)分;其中优7例,良2例,差1例。结论:分期手术治疗开放性中足骨折脱位损伤可以有效避免各种严重并发症的发生,临床疗效满意。
Background: Open midfoot fracture and dislocation can result in high disability rate and its treatment is very difficult. Staged surgical treatment provides new ideas for it. Objective: To explore the methods and effects of staged surgical treatment for open midfoot fracture and dislocation. Methods: Ten patients with open midfoot fracture and dislocation who were treated by staged surgery in our hospital from August 2013 to May 2018 were retrospective analyzed. In the first stage,emergency debridement was performed thoroughly, wounds were repaired, and the fracture and dislocation were simply fixed.In the second stage, the operation timing and internal fixation method were individually selected according to the soft tissue repair and the reduction and fixation of the bones and joints of the midfoot. The fracture healing time and complications were observed. The foot function was evaluated by the middle foot score of American Orthopedic Foot Ankle Society(AOFAS) at the last follow-up. Results: The mean duration of follow-up was(14.5±3.8) months(range, 11-23 months) in all the patients. The mean bone healing time was(14.2±2.3) weeks(range, 11-17 weeks). No complications such as deep infection, osteomyelitis,nonunion or internal fixation failure were found. One patient developed severe traumatic arthritis in the late stage, and the symptoms were significantly relieved after joint fusion again. At the last follow-up, the mean AOFAS midfoot score was 84.3±13.6, including excellent in 7 cases, good in 2, and poor in one. Conclusions: Staged surgery for the treatment of open midfoot fracture and dislocation can effectively avoid various serious complications, and clinical effect is satisfactory.
作者
曾林如
罗淦
杨军
岳振双
辛大伟
徐灿达
ZENG Linru;LUO Gan;YANG Jun;YUE Zhenshuang;XIN Dawei;XU Canda(Department of Orthopaedics,Xiaoshan District Traditional Chinese Medicine Hospital,Hangzhou 311201,China)
出处
《中华骨与关节外科杂志》
2020年第7期534-537,共4页
Chinese Journal of Bone and Joint Surgery
关键词
开放性中足损伤
骨折
脱位
分期手术治疗
内固定
Open Midfoot Injury
Fracture
Dislocation
Staged Surgical Treatment
Internal Fixation
