【作者】 倪喆； 刘佳； 杨述华； 刘勇； 王永清； 夏天；

【机构】 华中科技大学同济医学院附属协和医院；

【摘要】 [目的]探讨跖跗关节损伤的诊断及不同手术方式治疗跖跗关节损伤的临床疗效。[方法]自2008年5月~2010年12月应用石膏固定2例,闭合复位经皮内固定治疗跖跗关节损伤11例,开放复位内固定治疗跖跗关节损伤20例,二期关节融合术2例。[结果]35例随访12—36周(平均22周)。克氏针松动8例,螺钉断钉2例,创伤后关节炎8例。依据美国矫形足踝协会(AOFAS)足评分标准对患足术后的功能进行评定:优11例,良18例,可5例,差1例。[结论]解剖复位、牢靠固定是治疗跖跗关节损伤的基本原则。中间柱复位并沿Lisfranc韧带方向固定内侧楔骨和第2跖骨基底部是重建跖跗关节复合体稳定性的关键,并且需要重视对跖跗关节的整体化治疗。更多还原

【Abstract】 [Objective]To investigate the diagnosis and the clinical results of different treatments of tarsometatarsal joint injuries.[Methods]From May 2008 to December 2010,2 cases were treated with cast immobilization,11 cases were treated with close reduction and internal fixation.20 cases were treated with open reduction and internal fixation.2 cases were treated with secondary stage arthrodesis.[Results]All cases follows up from 12 months to 36 months.Complications were looseness of K-wires in 8 cases,screw breakage in 2 cases and traumatic arthritis in 8 cases.There were excellent in 10 patients,good in 18 patients,fair in 5 patients and bad in 1patient according to the American Orthopaedic Foot and Ankle Society(AOFAS) midfoot score.[Conclusion]Anatomical reduction and stable fixation of Lisfranc injuries is the principle that leads to the best outcomes.Reduction of the middle column with screw insertion along the direction of the Lisfranc ligament is the key to restablishment of the tarsometatarsal joint complex.Emphasis on the whole treatment of the Lisfranc joint.更多还原