65-跖跗關節新鲜损伤与陈旧性损伤的手术疗效对比研究 二院 余霄.doc

跖跗关节新鲜损伤与陈旧性损伤的手术疗效对比研究 余霄 蒋鲁勇 刘丙根 庞清江 杨长春 基金项目：宁波市自然科学基金（2014A610250） 作者单位：315010，宁波市第二医院骨科 【摘要】目的：比较跖跗关节新鲜损伤与陈旧性损伤的手术疗效。方法：选取2010年10月至2013年10月，我科收治的24例跖跗关节损伤患者，其中12例患者为新鲜损伤，并在伤后7天内进行了切开复位内固定治疗，另外12例为陈旧性损伤，在伤后4～24周发现漏诊，予切开复位内固定或跖跗关节融合治疗。所有患者平均随访24个月（12个月～48个月）。采用AOFAS中足评分评价足部功能。结果：新鲜损伤组AOFAS评分平均为94.08分，而陈旧性损伤组AOFAS评分平均为79.92分，新鲜损伤组在疼痛，活动度，行走距离等评分上显著优于陈旧性损伤组 (P0.05)。造成患者陈旧性损伤最主要的原因是初诊时急诊医师的漏诊。结论：对新鲜的跖跗关节损伤，只要能获得精确的解剖复位和良好的固定，一般都能获得比陈旧性损伤更为满意的效果。但陈旧性的跖跗关节损伤，行切开复位内固定术或关节融合术也能明显缓解疼痛，改善功能。 【关键词】新鲜损伤；陈旧性损伤；跖跗关节；手术治疗 The comparison of surgical outcome between fresh tarsometatarsal joint injury and obsolete injury Yu xiao, Jiang Lu-yong, Liu Bing-gen, Pang Qing-jiang and Yang Chang-chun 【Abstract】Objective: To compare the surgical outcome between fresh injury and obsolete injury of tarsometatarsal joint. Methods: From Oct 2010 to Oct 2013, 24 cases of tarsometatarsal joint injuries were treated in our department. Among them, 12 were suffered from fresh injury and were undergone open reduction and internal fixation within 7 days. The other 12 cases were suffered from obsolete injury, who were found misdiagnosis 4~24 weeks after injury and were undergone open reduction and internal fixation or tarsometatarsal joint arthrodesis. All the cases were accepted a mean follow-up period of 24 months (12-48 months). The foot function was evaluated by the AOFAS midfoot score system. Results: The mean AOFAS scores in fresh injury group were 94.08 and the scores in obsolete injury group were 79.92. The scores of fresh injury group are statistical significant in pain, activity limitations and walking distance compared with the obsolete injury group. The main cause of obsolete injury is the misdiagnosis in the Emergent department. Conclusion: To the patients of fresh tarsometatarsal joint injury, as long as accurate anatomical reduction and good fixation can be acquired, it can obtain more satisfactory results than the patients of obsolete injury. However, to the patients of obsolete inj