[1]刘欢欢,游镇君,冯玉爽,等.术后开始负重时间对第五跖骨基底部骨折手术效果影响的临床研究[J].中医正骨,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.
点击复制

术后开始负重时间对第五跖骨基底部骨折手术效果影响的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年03期
页码:
26-30
栏目:
临床研究
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:
刘欢欢; 游镇君; 冯玉爽; 余昆
(嘉兴市第一医院,浙江 嘉兴 314001)
Author(s):
LIU Huanhuan; YOU Zhenjun; FENG Yushuang; YU Kun
The First Hospital of Jiaxing,Jiaxing 314001,Zhejiang,China
关键词:
负重;  第五跖骨;  骨折固定术; 内;  临床试验
Keywords:
weight-bearing;  fifth metatarsal bone;  fracture fixation; internal;  clinical trial
摘要:
目的:观察术后开始负重时间对第五跖骨基底部骨折手术效果的影响。方法:选择68例采用切开复位内固定手术治疗的第五跖骨基底部骨折患者,患者术后均以短腿石膏固定。34例术后3 d开始完全负重行走(早负重组),其余34例术后4周开始完全负重行走(晚负重组)。比较2组患者的骨折愈合时间、骨折部位骨吸收发生率、足部疼痛视觉模拟量表(visual analogue scale,VAS)评分、美国足与踝关节协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分及并发症发生情况。结果:①骨折愈合情况。所有患者均获得12个月随访。2组患者的骨折均愈合,骨折愈合时间的差异无统计学意义[(6.3±1.1)周,(6.8±1.6)周,t=1.502,P=0.138]。早负重组2例患者发生骨折部位骨吸收、晚负重组9例患者发生骨折部位骨吸收,晚负重组骨折部位骨吸收发生率高于早负重组(χ2=5.314,P=0.021)。②足部疼痛VAS评分。时间因素和分组因素不存在交互效应(F=1.813,P=0.174)。2组患者足部疼痛VAS评分总体比较,差异无统计学意义,即不存在分组效应(F=0.978,P=0.432)。手术后不同时间点间足部疼痛VAS评分的差异有统计学意义,即存在时间效应(F=11.381,P=0.000); 2组患者足部疼痛VAS评分随时间延长均呈降低趋势[早负重组:(3.1±1.6)分,(1.7±2.3)分,(0.1±0.4)分,F=0.951,P=0.000; 晚负重组:(3.5±2.6)分,(2.3±2.8)分,(0.2±0.6)分,F=5.739,P=0.000]。③AOFAS踝与后足功能评分。时间因素和分组因素不存在交互效应(F=1.947,P=0.159)。早负重组的AOFAS踝与后足功能评分总体高于晚负重组(F=2.018,P=0.039)。手术后不同时间点间AOFAS踝与后足功能评分的差异有统计学意义,即存在时间效应(F=13.916,P=0.000); 2组患者AOFAS踝与后足功能评分随时间延长均呈升高趋势[早负重组:(75.3±6.8)分,(89.7±9.3)分,(99.1±7.7)分,F=0.837,P=0.000; 晚负重组:(72.5±9.9)分,(82.3±10.1)分,(96.8±7.6)分,F=6.147,P=0.000]。④并发症发生情况。2组患者均未发生切口感染、骨折再移位等并发症。结论:第五跖骨基底部骨折采用切开复位内固定手术治疗后,无论早负重还是晚负重均可获得满意的临床疗效,而且安全性较高,但早负重更有利于足踝功能恢复、降低骨折部位骨吸收发生率。
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.

参考文献/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] 赵玉果,汤立新,叶向阳,等.带线锚钉内固定治疗第五跖骨基底部撕脱骨折[J].中医正骨,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.骨与关节损伤[M].4版.北京:人民卫生出版社,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 本文编辑:李晓乐)

更新日期/Last Update: 1900-01-01