成人骰骨相关解剖及其压缩骨折的治疗

doi:10.3760/cma.j.cn101202-20190724-00232

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摘要目的探讨成人骰骨解剖特点,总结骰骨闭合压缩骨折的治疗方法。方法对5例新鲜冰冻人体足标本进行解剖,分析骰骨及其周围解剖结构特点。回顾性分析2009年5月—2016年5月唐山市第二医院收治的78例(78足)成人骰骨压缩骨折患者的临床资料。其中男70例,女8例;年龄19～64岁,平均38.8岁。受伤至入院时间2～72 h ,平均8.5 h。致伤原因:扭伤26例,车祸伤13例,高处坠落伤21例,重物压伤18例。按骰骨骨折分型标准分为Ⅰ型8足、Ⅱ型42足、Ⅲ型28足。5例(5足)患者拒绝手术治疗,采用膝下石膏托外固定保守治疗;73例(73足)患者行切开复位内固定术,其中58例(58足)术中采用植骨修复遗留缺损。术后观察患者骨折愈合情况,足部疼痛肿胀情况。术后1年依据美国足与踝关节协会(AOFAS)评分标准评足部功能。结果骰骨解剖观察显示:骰骨内侧长、外侧短,主要为松质骨;骰骨主要与第4、5跖骨基底、第3楔骨、跟骨周围骨质相关节,其周围有坚强的韧带组织保护。78例(78足)骰骨压缩骨折患者均获随访,随访时间2～9年,平均33个月。5例(5足)保守治疗患者,伤后6～8周畸形愈合。73例手术治疗患者中,9例(9足)骨折复位不充分,术后6～8周畸形愈合;64足骨折复位充分,术后8～12周骨折愈合。患者随访期间均无微型钢板引起的腓骨肌腱激惹、断裂,无骨关节炎、足外侧柱短缩及骰骨处明显疼痛等相关并发症发生。术后1年根据AOFAS标准评分75～97分,平均93.5分;依据评分评定足部功能:优64例(64足),良14例(14足)。结论通过对新鲜人体足标本的解剖观察,了解其解剖形态特点,对骰骨压缩骨折的治疗具有临床指导意义。对于骰骨闭合压缩骨折,采用微型接骨板“桥”式支撑内固定的方法取得良好的临床疗效。

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	高岩
	杜晓健
	张玲
	张文龙
	陈江华
	刘洪达
	闫荣亮

关键词 ：跗骨, 骰骨, 骨折,压缩性, 解剖, 骨折固定术

Abstract：Objective This study aimed to explore the anatomical characteristics of adult cuboid bone and summarize the treatment of the compression fracture of cuboid bone.Methods The anatomy and the characteristics of the cuboid bone were evaluated using the anatomy of five fresh frozen human foot specimens. The clinical data of 78 cases (78 feet) of adult cuboid compression fracture admitted to Tangshan Second Hospital from May 2009 to May 2016 were analyzed retrospectively. The patients included 70 males and 8 females, an mean age of 38.8 years (19-64 years). The time from injury to admission was 2-72 h (mean 8.5 h). Five patients (5 feet) refused the operation and were treated conservatively by using external fixation via a plaster under the knee. The remaining 73 patients (73 feet) underwent open reduction and internal fixation, and 58 patients (58 feet) underwent bone graft. The postoperative observation of fracture healing, foot pain, and swelling was conducted. A year after the operation, the foot function was evaluated in accordance with the American Orthopedic Foot and Ankle Society (AOFAS) standard.Results The anatomical observation of the cuboid showed that the medial side of the cuboid was long and that the lateral side was short, mainly cancellous bone. The cuboid bone was mainly connected with the 4th and 5th metatarsus base, the 3rd cuneiform bone and the calcaneus, protected by strong ligament tissue. A long peroneal tendon, the third peroneal tendon, a short peroneal tendon, and the third cuneiform bone block were observed on the lateral, dorsal, metatarsal, and medial sides, respectively, of the cuboid. A total of 78 cases (78 feet) of cuboid compression fracture were followed up for 2-9 years (mean 33 months). Five cases (5 feet) were treated conservatively, and the deformity healed 6-8 weeks after the injury. Among the remaining 73 patients, 9 cases (9 feet) had inadequate reduction and malunion 6-8 weeks after the operation, whereas 64 cases (64 feet) had sufficient reduction 8-12 weeks after the operation. During the follow-up period, no complication, such as osteoarthritis, foot lateral column shortening, and obvious pain, in the cuboid bone occurred. One year after the operation, the score was 75-97 points (mean=93.5 points) on the basis of the AOFAS standard. In accordance with the score, the foot function was evaluated in 64 excellent (64 feet) and 14 good (14 feet) cases.Conclusions The anatomical characteristics of cuboid compression fracture are understood through the anatomical observation of fresh human foot specimens, for the treatment of compression fracture of the cuboid bone has clinical guiding significance. For the closed compression fracture of the cuboid bone, the “bridge-type” internal fixation method with miniplate has achieved a good clinical effect.

Key words： Tarsal bones Cuboid bone Fractures, compression Anatomy Fracture fixation

收稿日期: 2019-07-24

通讯作者: 杜晓健,Email:dxjzl.good@163.com

引用本文:

高岩, 杜晓健, 张玲, 张文龙, 陈江华, 刘洪达, 闫荣亮. 成人骰骨相关解剖及其压缩骨折的治疗[J]. 中华解剖与临床杂志, 2020, 25(3): 238-242.
Gao Yan, Du Xiaojian, Zhang Ling, Zhang Wenlong, Chen Jianghua, Liu Hongda, Yan Rongliang. Adult cuboid anatomy and surgical treatment of cuboid compression fractures. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 238-242.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20190724-00232 或 http://www.cjac.com.cn/CN/Y2020/V25/I3/238

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