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[1]劉歡歡,游鎮(zhèn)君,馮玉爽,等.術(shù)后開始負(fù)重時(shí)間對(duì)第五跖骨基底部骨折手術(shù)效果影響的臨床研究[J].中醫(yī)正骨,2021,33(03):26-30.
　LIU Huanhuan,YOU Zhenjun,FENG Yushuang,et al.Influence of postoperative full weight-bearing walking start time on clinical therapeutic effects of surgery for treatment of the fifth metatarsal base fractures:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(03):26-30.
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術(shù)后開始負(fù)重時(shí)間對(duì)第五跖骨基底部骨折手術(shù)效果影響的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年03期
頁(yè)碼:
26-30
欄目:
臨床研究
出版日期:
2021-03-20

文章信息/Info

Title:
Influence of postoperative full weight-bearing walking start time on clinical therapeutic effects of surgery for treatment of the fifth metatarsal base fractures:a clinical study
作者:
劉歡歡; 游鎮(zhèn)君; 馮玉爽; 余昆
(嘉興市第一醫(yī)院,浙江 嘉興 314001)
Author(s):
LIU Huanhuan; YOU Zhenjun; FENG Yushuang; YU Kun
The First Hospital of Jiaxing,Jiaxing 314001,Zhejiang,China
關(guān)鍵詞:
負(fù)重;  第五跖骨;  骨折固定術(shù); 內(nèi);  臨床試驗(yàn)
Keywords:
weight-bearing;  fifth metatarsal bone;  fracture fixation; internal;  clinical trial
摘要:
目的:觀察術(shù)后開始負(fù)重時(shí)間對(duì)第五跖骨基底部骨折手術(shù)效果的影響。方法:選擇68例采用切開復(fù)位內(nèi)固定手術(shù)治療的第五跖骨基底部骨折患者,患者術(shù)后均以短腿石膏固定。34例術(shù)后3 d開始完全負(fù)重行走(早負(fù)重組),其余34例術(shù)后4周開始完全負(fù)重行走(晚負(fù)重組)。比較2組患者的骨折愈合時(shí)間、骨折部位骨吸收發(fā)生率、足部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分、美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分及并發(fā)癥發(fā)生情況。結(jié)果:①骨折愈合情況。所有患者均獲得12個(gè)月隨訪。2組患者的骨折均愈合,骨折愈合時(shí)間的差異無統(tǒng)計(jì)學(xué)意義[(6.3±1.1)周,(6.8±1.6)周,t=1.502,P=0.138]。早負(fù)重組2例患者發(fā)生骨折部位骨吸收、晚負(fù)重組9例患者發(fā)生骨折部位骨吸收,晚負(fù)重組骨折部位骨吸收發(fā)生率高于早負(fù)重組(χ2=5.314,P=0.021)。②足部疼痛VAS評(píng)分。時(shí)間因素和分組因素不存在交互效應(yīng)(F=1.813,P=0.174)。2組患者足部疼痛VAS評(píng)分總體比較,差異無統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.978,P=0.432)。手術(shù)后不同時(shí)間點(diǎn)間足部疼痛VAS評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=11.381,P=0.000); 2組患者足部疼痛VAS評(píng)分隨時(shí)間延長(zhǎng)均呈降低趨勢(shì)[早負(fù)重組:(3.1±1.6)分,(1.7±2.3)分,(0.1±0.4)分,F=0.951,P=0.000; 晚負(fù)重組:(3.5±2.6)分,(2.3±2.8)分,(0.2±0.6)分,F=5.739,P=0.000]。③AOFAS踝與后足功能評(píng)分。時(shí)間因素和分組因素不存在交互效應(yīng)(F=1.947,P=0.159)。早負(fù)重組的AOFAS踝與后足功能評(píng)分總體高于晚負(fù)重組(F=2.018,P=0.039)。手術(shù)后不同時(shí)間點(diǎn)間AOFAS踝與后足功能評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=13.916,P=0.000); 2組患者AOFAS踝與后足功能評(píng)分隨時(shí)間延長(zhǎng)均呈升高趨勢(shì)[早負(fù)重組:(75.3±6.8)分,(89.7±9.3)分,(99.1±7.7)分,F=0.837,P=0.000; 晚負(fù)重組:(72.5±9.9)分,(82.3±10.1)分,(96.8±7.6)分,F=6.147,P=0.000]。④并發(fā)癥發(fā)生情況。2組患者均未發(fā)生切口感染、骨折再移位等并發(fā)癥。結(jié)論:第五跖骨基底部骨折采用切開復(fù)位內(nèi)固定手術(shù)治療后,無論早負(fù)重還是晚負(fù)重均可獲得滿意的臨床療效,而且安全性較高,但早負(fù)重更有利于足踝功能恢復(fù)、降低骨折部位骨吸收發(fā)生率。
Abstract:
Objective:To observe the influence of postoperative full weight-bearing walking start time on clinical therapeutic effects of surgery for treatment of the fifth metatarsal base fractures.Methods:The medical records of 68 patients with the fifth metatarsal base fractures were analyzed retrospectively.The patients received surgery of open reduction and internal fixation and their affected limbs were fixed with short-leg casts after the surgery.The full weight-bearing walking were performed at 3 days after the surgery in 34 patients(early weight-bearing(EWB)group)and at 4 weeks after the surgery in the others(late weight-bearing(LWB)group)respectively.The fracture healing time,incidence of bone resortion at fractured site,foot pain visual analogue scale(VAS)scores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores and complication incidence were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 12 months.All fractures healed in the 2 groups,and there was no statistical difference in fracture healing time between the 2 groups(6.3±1.1 vs 6.8±1.6 weeks,t=1.502,P=0.138).The bone resortion was found at fractured site in 2 patients in EWB group and 9 patients in LWB group.The incidence of bone resortion at fractured site was higher in LWB group compared to EWB group(χ2=5.314,P=0.021).There was no interaction between time factor and group factor in foot pain VAS scores(F=1.813,P=0.174).There was no statistical difference in foot pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=0.978,P=0.432).There was statistical difference in foot pain VAS scores between different timepoints after the surgery,in other words,there was time effect(F=11.381,P=0.000).The foot pain VAS scores presented a time-dependent decreasing trend in the 2 groups(EWB group:3.1±1.6,1.7±2.3,0.1±0.4 points,F=0.951,P=0.000; LWB group:3.5±2.6,2.3±2.8,0.2±0.6 points,F=5.739,P=0.000).There was no interaction between time factor and group factor in AOFAS ankle-hindfoot function scores(F=1.947,P=0.159).The AOFAS ankle-hindfoot function scores were higher in EWB group compared to LWB group in general,in other words,there was group effect(F=2.018,P=0.039).There was statistical difference in AOFAS ankle-hindfoot function scores between different timepoints after the surgery,in other words,there was time effect(F=13.916,P=0.000).The AOFAS ankle-hindfoot function scores presented a time-dependent increasing trend in the 2 groups(EWB group:75.3±6.8,89.7±9.3,99.1±7.7 points,F=0.837,P=0.000; LWB group:72.5±9.9,82.3±10.1,96.8±7.6 points,F=6.147,P=0.000).No complications such as incision infection and fracture re-displacement were found in the 2 groups.Conclusion:For patients who received surgery of open reduction and internal fixation for treatment of the fifth metatarsal base fractures,both EWB and LWB can achieve good clinical curative effects with high safety.However,the former is more conducive to foot and ankle function recovery and reducing incidence of bone resortion at fractured site compared to the latter.

參考文獻(xiàn)/References:

[1] MAGEED M,STEINBERG T,DRUMM N,et al.Internal fixation of proximal fractures of the 2nd and 4th metacarpal and metatarsal bones using bioabsorbable screws[J].Aust Vet J,2018,96(3):76-81.
[2] 趙玉果,湯立新,葉向陽,等.帶線錨釘內(nèi)固定治療第五跖骨基底部撕脫骨折[J].中醫(yī)正骨,2019,31(7):55-57.
[3] ZHAO J,YU B,XIE M,et al.Surgical treatment of zone 1 fifth metatarsal base fractures using the locking compression plate distal ulna hook plate[J].J Am Podiatr Med Assoc,2017,107(5):369-374.
[4] XIE L,GUO X,ZHANG S J,et al.Locking compression plate distal ulna hook plate fixation versus intramedullary screw fixation for displaced avulsion fifth metatarsal base fractures:a comparative retrospective cohort study[J].BMC Musculoskelet Disord,2017,18(1):405.
[5] VALKIER C,FALLAT L M,JARSKI R.Conservative versus surgical management of fifth metatarsal avulsion fractures[J].J Foot Ankle Surg,2020,59(5):988-992.
[6] BAUMBACH S F,PRALL W C,KRAMER M,et al.Functional treatment for fractures to the base of the 5th meta-tarsal-influence of fracture location and fracture characte-ristics[J].BMC Musculoskelet Disord,2017,18(1):534.
[7] AKIMAU P I,CAWTHRON K L,DAKIN W M,et al.Symptomatic treatment or cast immobilisation for avulsion fractures of the base of the fifth metatarsal:a prospective,randomised,single-blinded non-inferiority controlled trial[J].Bone Joint J,2016,98-B(6):806-811.
[8] MALLEE W H,WEEL H,VAN DIJK C N,et al.Surgical versus conservative treatment for high-risk stress fractures of the lower leg(anterior tibial cortex,navicular and fifth metatarsal base):a systematic review[J].Br J Sports Med,2015,49(6):370-376.
[9] TORG J S,BALDUINI F C,ZELKO R R,et al.Fractures of the base of the fifth metatarsal distal to the tuberosity.Classification and guidelines for non-surgical and surgical management[J].J Bone Joint Surg Am,1984,66(2):209-214.
[10] BEAN B A,SMYTH N,ABBASI P,et al.Biomechanical comparison of hook plate vs headless compression screw fixation of large fifth metatarsal base avulsion fractures[J].Foot Ankle Int,2021,42(1):89-95.
[11] O’MALLEY M,DESANDIS B,ALLEN A,et al.Operative treatment of fifth metatarsal jones fractures(zonesⅠandⅡ)in the NBA[J].Foot Ankle Int,2016,37(5):488-500.
[12] WU G B,LI B,YF Y.Comparative study of surgical and conservative treatments for fifth metatarsal base avulsion fractures(typeⅠ)in young adults or athletes[J].J Orthop Surg(Hong Kong),2018,26(1):230.
[13] DINEEN H,MURPHY T D,MANGAT S,et al.Functional outcomes for nonoperatively treated proximal fifth metatarsal fractures[J].Orthopedics,2017,40(6):e1030-e1035.
[14] 王亦璁.骨與關(guān)節(jié)損傷[M].4版.北京:人民衛(wèi)生出版社,2007:1573-1575.
[15] KITAOKA H B,ALEXANDER I J,ADELAAR R S,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[16] NISHIKAWA D,AIRES D F,SAITO G H,et al.Treatment of zone 1 fractures of the proximal fifth metatarsal with CAM-Walker boot vs hard-soled shoes[J].Foot Ankle Int,2020,41(5):508-512.
[17] LEE K T,KIM K C,YOUNG K W,et al.Conservative treatment of refractures after modified tension band wiring of fifth metatarsal base stress fractures in athletes[J].J Orthop Surg(Hong Kong),2020,28(2):230.
[18] VAN DIJK P A,BREUKING S,GUSS D,et al.Optimizing surgery of metaphyseal-diaphyseal fractures of the fifth metatarsal:a cadaveric study on implications of intramedullary screw position,screw parameters and surrounding anatomic structures[J].Injury,2020,51(12):2887-2892.
[19] WANG Y,GAN X,LI K,et al.Comparison of operative and non-operative management of fifth metatarsal base fracture:a meta-analysis[J].PLoS One,2020,15(8):151.
[20] CHAN J J,MOHAMADI A,KAISER P,et al.Factors in-fluencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs[J].Foot Ankle Surg,2020,26(4):464-468.
[21] BIZ C,ZAMPERETTI M,GASPARELLA A,et al.Early radio-graphic and clinical outcomes of minimally displaced proximal fifth metatarsal fractures:cast vs functional bandage[J].Muscles Ligaments Tendons J,2017,7(3):532-540.
[22] CHOI Y N,CHOI Y R,SEO J H,et al.Results of non-operative treatment of the zoneⅠ,Ⅱfifth metatarsal base fracture[J].J Korean Foot Ankle Soc,2011,15(4):207-211.(收稿日期:2020-11-02 本文編輯:李曉樂)

更新日期/Last Update: 1900-01-01