中足损伤畸形愈合的分型及手术治疗VIP专享VIP免费

中华创伤骨科杂志2014年8月第16卷第8期ChinJOflhopTrauma．August2014．V01．16．No．8中足损伤畸形愈合的分型及手术治疗俞光荣余斌李春光杨云峰李兵金丹相大勇张明珠李山珠伊力哈木·托合提【摘要】目的提出中足损伤畸形愈合的分型，并探讨中足损伤畸形愈合的临床治疗特点及要点。方法回顾性分析自2004年6月至2012年6月收治且获得随访的22例中足损伤畸形愈合患者资料，男19例，女3例；年龄16～65岁，平均37．8岁。其中单纯Lisfranc关节骨折脱位6例，严重Lisfranc关节复合体损伤伴骰骨压缩骨折7例，严重Lisfranc关节复合体损伤合并舟骨骨折9例。足背部软组织条件较差，有大面积瘢痕者8例。根据自己提出的分型进行分型：Ia型2例，Ic型4例；Ⅱa型9例；Ⅲa型4例，111C型3例。根据畸形形态选用皮瓣移植、截骨矫形关节融合纠正畸形，恢复力线。术后通过临床检查及X线片进行随访，临床评估采用疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)中足评分。结果所有患者术后获15～53个月(平均34．7个月)随访。末次随访时患者的VAS评分为0～6分，平均2．0分；AOFAS中足评分为73～94分，平均83．9分，优良率为81．8％。1例患者术后3年行走时仍存在中足疼痛，其余患者恢复良好，融合术后无骨不连发生。结论自己提出的分型有助于中足损伤畸形愈合的手术治疗，可获得满意疗效。稳定受伤关节，恢复足部力线和足弓是获得良好疗效的关键。【关键词】足损伤；足畸形，获得性；外科手术Typingandoperativemanagementofmalunionaftermidfootinjuryn￡Guangrong+．YuBin9．LiChunguang，eta1．+DepartmentofOrthopaedics，TongjiHospital，TongiiUniversit)"，Sixanghai200065，China．’DepartmentofOrthopaedicTrauma，Nar(ungHospital，SouthernMedicalUniversit)，Guangzhou510515．ChinaSupportedbyNationalNaturalScienceFoundationofChinar8137201，JandScienceandTecht20log)Projects矿XinjiangUygurAutonomousRegionf2013911112JYuGuangrongandYuBinarethefirstauthorswhocontributedeqaaU)’tothisarticle【Abstract】ObjectiveTocharacterizeclinicaltreatnlentofthemalunionariel·midfootinjury．MethodsAretrospectivestudywascarriedoutofthe22casesofmalunionfollowingcomplexmidfootinjurywhohadbeenadmittedtoourhospitalsfromJune2004throughJune2012．Theywere19menand3wonIcu，16to65yearsofage(mean，37．8years)．Therewere6casesofLisflancjointinjmy，7casesofLisfi’ancjointcomplexinjurycombinedwithcuboidcompressionfractureand9casesofLisfrancjointcomplexinjurycombinedwithnavieularfracture．Eightpatientspresentedwithpoorsofttissueandmassi、,escaratthedorsalfoot．Thefootdeformitywascategorizedinto3typesand3subtypesrepectively，withtypeIindicatingnormalfootarch(typeIaforefootabduction，typeIbforefootadductionandtypeIcnormalforefootj，type1IPesCavusdeformity(typeHacombinationwithforefootabduction，type111)combinationwithforefootadduction，andtypellcnormalforefoot)，andtypeⅢflatfootdeformity(typeⅢacombinationwithforefi)otabduction，typeⅢbcombinationwithforefootadduction，andtypeⅢCnormalforefoot)．Therewere2casesoftypeIa，4casesoftypeIc，9casesoftypeHa，4casesoftype11Ia，and3casesoftypeⅢCinourcohort．Accordingtothemaluniontyping，fascio—cutaneousflap，osteotomy，jointarthrodesis，orrealignmentwasusedtocorrectdeformity．ClinicaloutcomeswereevaluatedbyAmericanOrthopaedicFootandAnkleSociety(AOFAS)midfootScoreandvisualanaloguescale(VAS)．ResultsAllthepatientswerefollowedupforanaverageof34．7months(range，from15to53months)．ThemeanVASscorewas2．0points(range，from0to6points)andthemeanAOFASscorewas83．9points(range，from73to94points)atthelastfollow—up，givingDOI：10．3760／cma．j．ISSfl．1671—7600．2014．08．001基金项目：国家自然科学基金(81372011)；自治区...