戴季林 夏增兵 胡文林 朱建祥

[摘要] 目的 探讨跖跗关节骨折手术中空心螺钉固定对治疗效果以及术后并发症情况的影响。 方法 选择跖跗关节骨折患者90例进行临床研究，按照随机数字表法将其分为三组，各30例，分别采取背侧钢板内固定、空心螺钉单次贯穿及空心螺钉2次贯穿关节面内固定治疗。分析三组患者第2跖骨底间的平移位移及外展加载位移，分析比较其生物力学效果、AOFAS评分及术后的并发症发生情况。 结果 空心螺钉单次贯穿固定组的轴向加载位移及外展加载位移均最小；空心螺钉单次贯穿固定组患者骨折愈合时间在三组患者中最短，AOFAS评分在三组患者中最高；且空心螺钉2次贯穿固定组的创伤性关节炎发生率最高，差异有统计学意义（P<0.05）。 结论 空心螺钉固定中，特别是空心螺钉单次贯穿固定能够有效保证踝关节暴露充分，融合接触面积大，而且手术操作方便，固定效果牢固，是治疗跖跗关节骨折病损的有效方法，值得临床推荐。

[关键词] Lisfranc骨折；Lisfranc中柱损伤；空心螺钉固定；术后并发症

[中图分类号] R687.3 [文献标识码] B [文章编号] 1673-9701（2018）30-0068-03

[Abstract] Objective To analyze and discuss the effect of hollow screw fixation on the efficacy and postoperative complications in the operation of tarsometatarsal joint. Methods 90 patients with tarsometatarsal joint fractures were selected for the clinical study. According to the random number table method， they were divided into 3 groups， with 30 cases in each group. Dorsal plate internal fixation， hollow screw single penetration and hollow screw double penetration of joint surface internal fixation were performed. The translational displacement between the second metatarsal base and the displacement during abduction loading in the three groups of patients were analyzed. Its biomechanical effects， AOFAS scores， and postoperative complications were analyzed and compared. Results The axial loading displacement and abduction displacement in the hollow screw single penetration fixation group were the smallest； the time of fracture healing were the shortest and AOFAS scores in the hollow screw single penetration fixation group were the highest among the three groups； in addition， the incidence rate of traumatic arthritis was the highest in hollow screw double penetration fixation group， and the difference was statistically significant（P<0.05）. Conclusion In the hollow screw fixation， especially the single penetration of the hollow screw can effectively ensure that the ankle joint is fully exposed and the fusion contact area is large. Moreover， the operation is convenient and the fixation effect is firm. It is an effective method in the treatment of tarsometatarsal joint fractures and is worthy of clinical recommendation.

[Key words] Lisfranc fractures； Lisfranc center pillar； Hollow screw fixation； Postoperative complications

臨床研究发现跖跗关节（Lisfranc）连接前足与中足，并在维持足弓稳定性中发挥重要的生理功能。有学者提出Lisfranc三柱理论，即包含了内侧柱，由第1楔骨和第1跖骨基底部构成；而中柱是由第2、3跖骨与第2、3跖骨基底部共同组成；此外，外侧柱是指骰骨前面的关节及第4、5跖骨基底部。三柱之中的中柱最为关键，中柱中的第2跖骨与第3楔骨形成卯榫状结构，是掌控整个关节稳定的关键[1，2]。跖跗关节骨折手术是治疗跖跗关节骨折脱位的有效方法之一，研究发现关节中柱损伤采用切开复位内固定手术治疗能够取得较好的临床疗效，目前临床常见固定物包括克氏针内固定、空心螺钉内固定及钢板内固定等[3，4]。……