| 开放性跖跗关节损伤的手术治疗 |
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投稿时间：2016-05-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 汤样华 |
TANG Yang-hua |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
tangyanghua168@sohu.com |
| 曾林如 |
ZENG Lin-ru |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 岳振双 |
YUE Zhen-shuang |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 辛大伟 |
XIN Da-wei |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 胡中青 |
HU Zhong-qing |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 徐灿达 |
XU Can-da |
杭州市萧山区中医院骨科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan TCM Hospital, Hangzhou 311201, Zhejiang, China |
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| 期刊信息：《中国骨伤》2017年，第30卷，第2期，第159-162页 |
| DOI：10.3969/j.issn.1003-0034.2017.02.013 |
| 基金项目: |
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中文摘要:
目的：探讨开放性跖跗关节损伤手术治疗方法及临床疗效。
方法：选择2011年3月至2015年1月手术治疗的21例开放性跖跗关节损伤患者，男14例，女7例；年龄20~75岁，平均45.6岁；左足13例，右足8例；交通伤5例，碾压伤6例，重物压伤10例。跖跗关节损伤根据Myerson分型：B2型5例，C1型9例，C2型7例。软组织损伤按照Gustilo分型：ⅡB型5例，ⅢA型10例，ⅢB型6例。采用分期手术治疗。术后观察骨折愈合及其并发症情况，并采用美国足踝外科协会（AOFAS）中足评分评价手术疗效。
结果：21例患者术后均获随访，时间11~40个月，平均16.2个月。骨性愈合时间10~16周，平均12.3周。未并发深部感染、骨不连及骨髓炎等并发症。末次随访AOFAS中足评分为83.0±14.9；优9例，良8例，中2例，差2例。2例患者因并发严重创伤性关节炎再次行跖跗关节融合术。
结论：对于开放性跖跗关节损伤的治疗，急诊合理清创，全面评估软组织损伤情况，正确把握内固定的手术指征及时机，可以降低深部感染及骨髓炎的发生率。 |
| 【关键词】足损伤 跖跗关节 分期治疗 内固定 |
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| Surgical treatment for open tarsometatarsal joint injury |
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ABSTRACT
Objective: To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries.
Methods: From March 2011 to January 2015,21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method,including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases,crush injury in 6 cases,heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury,5 cases were type B2,9 cases were type C1,and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury,5 cases were type ⅡB,10 cases were type ⅢA,6 cases were type ⅢB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS.
Results: All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection,nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9,9 cases got excellent results,8 good,2 fair,2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis.
Conclusion: For the treatment of open tarsometatarsal joint injury,reasonable debridement,comprehensive assessment for the soft tissue injury,correctly grasp the surgical indications and time of internal fixation,can reduce the incidence of deep infection and osteomyelitis. |
| KEY WORDS Foot injury Tarsometatarsal joint Staged treatment Internal fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 汤样华,曾林如,岳振双,辛大伟,胡中青,徐灿达.开放性跖跗关节损伤的手术治疗[J].中国骨伤,2017,30(2):159~162 |
| 英文格式: | TANG Yang-hua,ZENG Lin-ru,YUE Zhen-shuang,XIN Da-wei,HU Zhong-qing,XU Can-da.Surgical treatment for open tarsometatarsal joint injury[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(2):159~162 |
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