• 唐山市第二醫(yī)院（河北聯(lián)合大學(xué)附屬骨科醫(yī)院）足踝外科（河北唐山，063000）;

目的 探討新鮮閉合跗中關(guān)節(jié)骨折脫位的治療方法及療效。 方法2004年4月－2011年4月，收治73例（75足）新鮮閉合跗中關(guān)節(jié)骨折脫位，行閉合整復(fù)結(jié)合切開復(fù)位內(nèi)固定治療。男56例（58足），女17例（17足）；年齡19～62歲，平均35.8歲。高處墜落傷35例，扭傷4例，機(jī)器皮帶絞傷5例，重物砸傷9例，交通事故傷20例。傷后至入院時(shí)間為1 h 30 min～48 h，平均4.5 h。跗中關(guān)節(jié)損傷根據(jù)Main等分型標(biāo)準(zhǔn)：縱向壓縮型6足，內(nèi)側(cè)移位型33足，外側(cè)移位型17足，跖屈型9足，碾壓損傷型10足。合并中足骨折脫位34足，舟骨骨折6足，骰骨壓縮骨折18足，跟骨骨折8足，距骨骨折7足，脛距關(guān)節(jié)脫位2足，距下關(guān)節(jié)脫位2足，內(nèi)踝骨折1足。合并足急性筋膜室綜合征3足。 結(jié)果術(shù)后65例（67足）切口Ⅰ期愈合，8例（8足）Ⅱ期愈合。 62例（62足）獲隨訪，隨訪時(shí)間11個(gè)月～7年11個(gè)月，平均3年6個(gè)月。術(shù)后26足步行時(shí)足部疼痛，36足步行時(shí)自覺傷足僵硬或不適。X線片復(fù)查示，59足跗中關(guān)節(jié)骨折脫位及其合并傷均復(fù)位良好，無再脫位及骨折不愈合發(fā)生；3足發(fā)生足舟骨壞死，繼發(fā)扁平足，均行關(guān)節(jié)融合術(shù)。末次隨訪時(shí)，按照美國(guó)矯形足踝協(xié)會(huì)（AOFAS）標(biāo)準(zhǔn)評(píng)價(jià)足功能，為77～90分，平均88.6分。 結(jié)論根據(jù)術(shù)前對(duì)損傷的評(píng)估，采用手法整復(fù)結(jié)合內(nèi)固定（微型接骨板橋式支撐、空心螺釘聯(lián)合克氏針內(nèi)固定）治療存在不同合并損傷的跗中關(guān)節(jié)骨折脫位療效良好。

引用本文： 杜曉健,曲家富,曹立海,趙國(guó)志,閆榮亮,吳俊,彭義,王良. 新鮮閉合跗中關(guān)節(jié)骨折脫位的治療. 中國(guó)修復(fù)重建外科雜志, 2012, 26(10): 1178-1181. doi: 復(fù)制

1. 王正義, 張建中, 俞光榮. 足踝外科學(xué). 北京: 人民衛(wèi)生出版社, 2006: 191-192.
2. 劉凱, 李義凱, 邵紅巖, 等. 跗橫關(guān)節(jié)韌帶的解剖觀測(cè)及其意義. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2011, 26(12): 1108-1111.
3. 王亦璁. 骨與關(guān)節(jié)損傷. 3版. 北京: 人民衛(wèi)生出版社, 2005: 1122.
4. 杜曉健, 曲家富, 曹立海, 等. 微型接骨板橋式支撐固定治療骰骨壓縮骨折. 中國(guó)修復(fù)重建外科雜志, 2010, 24(10): 1273-1274.
5. Rammelt S, Grass R, Zwipp H. Nutcracker fractures of the navicular and cuboid. Ther Umsch, 2004, 61(7): 451-457.
6. Monsey RD, Levine BP, Trevino SG, et al. Operative treatment of acute displaced intra-articular calcaneus fractures. Foot Ankle Int, 2007, 16(2): 57-63.
7. 韓盧麗, 李良業(yè), 鄧江海. 外固定架固定治療跗中關(guān)節(jié)骨折脫位. 中國(guó)中醫(yī)骨傷科雜志, 2010, 18(8): 51-52.
8. 燕曉宇, 俞光榮, 丁祖泉, 等. 距舟關(guān)節(jié)的三維運(yùn)動(dòng)度及其臨床意義. 中國(guó)臨床解剖學(xué)雜志, 2007, 25(6): 693-695.
9. Andermahr J, Helling HJ, Maintz D, et al. The injury of the calcaneocuboid ligaments. Foot Ankle Int, 2000, 21(5): 379-384.
10. Leland RH, Marymont JV, Trevino SG, et al. Calcaneocuboid stability: a clinical and anatomic study. Foot Ankle Int, 2001, 22(11): 880-884.
11. Lohrer H, Arentz S. Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction. Foot Ankle Int, 2004, 25(5): 349-356.
12. Resnick D, Kang HS, Pretterklieber ML. Internal derangements of joints. 2nd ed. Philadelphia: Saunders, 2007: 2012．.
13. Taniguchi A, Tanaka Y, Takakura K, et al. Anatomy of the spring ligament. J Bone Joint Surg (Am), 2003, 85-A(11): 2174-2178.
14. Melão L, Canella C, Weber M, et al. Ligaments of the transverse tarsal joint complex: MRI-anatomic correlation in cadavers. AJR Am J Roentgenol, 2009, 193(3): 662-671.
15. Mengiardi B, Zanetti M, Schöttle PB, et al. Spring ligament complex: MR imaging-anatomic correlation and findings in asymptomatic subjects. Radiology, 2005, 237(1): 242-249.
16. Patil V, Ebraheim NA, Frogameni A, et al. Morphometric dimensions of the calcaneonavicular (spring) ligament. Foot Ankle Int, 2007, 28(8): 927-932.
17. Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg (Am), 1985, 67(4): 556-561.
18. Imhauser CW, Siegler S, Abidi NA, et al. The effect of posterior tibialis tendon dysfunction on the plantar pressure characteristics and the kinematics of the arch and the hindfoot. Clin Biomech (Bristol, Avon), 2004, 19(2): 161-169.
  1. 1. 王正義, 張建中, 俞光榮. 足踝外科學(xué). 北京: 人民衛(wèi)生出版社, 2006: 191-192.
  2. 2. 劉凱, 李義凱, 邵紅巖, 等. 跗橫關(guān)節(jié)韌帶的解剖觀測(cè)及其意義. 中國(guó)康復(fù)醫(yī)學(xué)雜志, 2011, 26(12): 1108-1111.
  3. 3. 王亦璁. 骨與關(guān)節(jié)損傷. 3版. 北京: 人民衛(wèi)生出版社, 2005: 1122.
  4. 4. 杜曉健, 曲家富, 曹立海, 等. 微型接骨板橋式支撐固定治療骰骨壓縮骨折. 中國(guó)修復(fù)重建外科雜志, 2010, 24(10): 1273-1274.
  5. 5. Rammelt S, Grass R, Zwipp H. Nutcracker fractures of the navicular and cuboid. Ther Umsch, 2004, 61(7): 451-457.
  6. 6. Monsey RD, Levine BP, Trevino SG, et al. Operative treatment of acute displaced intra-articular calcaneus fractures. Foot Ankle Int, 2007, 16(2): 57-63.
  7. 7. 韓盧麗, 李良業(yè), 鄧江海. 外固定架固定治療跗中關(guān)節(jié)骨折脫位. 中國(guó)中醫(yī)骨傷科雜志, 2010, 18(8): 51-52.
  8. 8. 燕曉宇, 俞光榮, 丁祖泉, 等. 距舟關(guān)節(jié)的三維運(yùn)動(dòng)度及其臨床意義. 中國(guó)臨床解剖學(xué)雜志, 2007, 25(6): 693-695.
  9. 9. Andermahr J, Helling HJ, Maintz D, et al. The injury of the calcaneocuboid ligaments. Foot Ankle Int, 2000, 21(5): 379-384.
  10. 10. Leland RH, Marymont JV, Trevino SG, et al. Calcaneocuboid stability: a clinical and anatomic study. Foot Ankle Int, 2001, 22(11): 880-884.
  11. 11. Lohrer H, Arentz S. Calcaneocuboid joint instability: a novel operative technique for anatomic reconstruction. Foot Ankle Int, 2004, 25(5): 349-356.
  12. 12. Resnick D, Kang HS, Pretterklieber ML. Internal derangements of joints. 2nd ed. Philadelphia: Saunders, 2007: 2012．.
  13. 13. Taniguchi A, Tanaka Y, Takakura K, et al. Anatomy of the spring ligament. J Bone Joint Surg (Am), 2003, 85-A(11): 2174-2178.
  14. 14. Melão L, Canella C, Weber M, et al. Ligaments of the transverse tarsal joint complex: MRI-anatomic correlation in cadavers. AJR Am J Roentgenol, 2009, 193(3): 662-671.
  15. 15. Mengiardi B, Zanetti M, Schöttle PB, et al. Spring ligament complex: MR imaging-anatomic correlation and findings in asymptomatic subjects. Radiology, 2005, 237(1): 242-249.
  16. 16. Patil V, Ebraheim NA, Frogameni A, et al. Morphometric dimensions of the calcaneonavicular (spring) ligament. Foot Ankle Int, 2007, 28(8): 927-932.
  17. 17. Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg (Am), 1985, 67(4): 556-561.
  18. 18. Imhauser CW, Siegler S, Abidi NA, et al. The effect of posterior tibialis tendon dysfunction on the plantar pressure characteristics and the kinematics of the arch and the hindfoot. Clin Biomech (Bristol, Avon), 2004, 19(2): 161-169.