摘要目的 探讨中足三柱理论在跖跗关节损伤治疗中的应用,以指导临床实践.方法 自2003年1月至2008年4月手术治疗跖跗关节骨折脱位38例,男24例,女14例;平均年龄37.1岁;左侧16例,右侧22例.开放性损伤11例,闭合性损伤27例;新鲜损伤34例,陈旧性损伤4例.按解剖三柱分类:单纯内侧柱损伤5例,内侧柱与中间柱损伤13例,中间柱与外侧柱损伤8例,单纯外侧柱损伤5例,三柱完全损伤7例.其中合并舟骨骨折6例,骰骨骨折5例,楔骨骨折12例,跖骨骨折21例.受伤至手术时间5～24 d,平均9.2 d.闭合性损伤依据跖跗损伤程度行空心钉或钢板固定,开放性损伤采用克氏针或结合足部微型支架固定. 结果 所有患者术后获平均16.5个月(12～25个月)随访,除2例开放性损伤患者出现创面感染给予二期皮瓣修复外,其余创口均一期愈合.X线评估30例患者足部三柱长度与横弓恢复良好,8例出现足弓塌陷.7例患者取出内固定后主诉负重疼痛.根据Hardcastal足部功能评分评估疗效:优18例,良11例,一般5例,差4例,优良率为76.3%.结论 中足三柱理论对跖跗关节损伤治疗有重要临床意义,术中需依次重建并牢固固定内侧柱、中间柱,外侧柱需弹性固定,同时必须注意对楔骨与骰骨的重建.

abstractsObjective To investigate how the three-column theory can be applied in the treatment of injuries of the tarsometatarsal joint. Methods From January 2003 to April 2008, 38 patients with fracture-dislocation of the tarsometatarsal joint were treated, including 11 open injuries. According to anatomical three-column classification, 5 cases involved the single medial column, 13 the medial and middle columns, 8 the middle and lateral columns, 5 the single lateral column, and 7 the three columns. The fractures were complicated with the scaphoid in 6 cases, the cuboid in 5, the cuneiform in 12, and the metatarsal in 21. Hollow screws or plates were used to fix the tarsometatarsal joint depending on the severity for closed injury, and K-wires with or without a micro-external fixator for open injury. Results All patients had a mean follow-up of 16.5 months (range, 12 to 25 months) . All the wounds healed primarily except 2 open cases that had to receive flap reconstruction due to wound infection. Radiological evaluation demonstrated that 30 cases restored anatomic configuration of the three columns and transverse arch, but 8 showed flatfoot deformity and 7 complained of pain after removal of implants. Evaluation by Hardcastal functional and radiological scoring system showed 18 excellent cases, 11 good ones, 5 fair ones and 4 poor ones, with a good to excellent rate of 76. 3%. Conclusions The three-column theory can provide significant guidance for clinical practice. The medial and middle columns need to de reconstructed and fixed firmly, and the lateral column needs elastic fixation. The cuneiform and cuboid bones must be reconstructed as well.