李佳+张巍+郝明+梁向党+张立海+唐佩福

    [摘要] 目的 探讨经皮空心螺钉与保守治疗第五跖骨基底部撕脱骨折的临床效果。 方法 回顾性分析2007年1月~2010年12月解放军总医院收治52例第五跖骨基底部撕脱骨折患者，其中34例采取经皮空心螺钉手术治疗(空心螺钉组)，18例患者采取保守治疗(保守治疗组)，比较分析两组患者愈合时间、愈合及预后情况(功能评分及疼痛评分)。 结果 52例患者获得随访，随访时间为12~36个月，平均18个月；经皮空心螺钉组骨折愈合时间为(10.2±2.3)周，美国足踝协会(AOFAS)中前足功能评分为(92.3±4.2)分，VAS疼痛评分为(0.9±0.4)分；保守治疗组骨折愈合时间为(12.2±1.2)周，AOFAS中前足功能评分为(89.0±3.2)分，视角模拟评分法(VAS)疼痛评分为(1.2±0.4)分；经皮空心螺钉组在骨折愈合时间(P=0.012)及AOFAS评分(P=0.005)方面优于保守治疗组，两组之间差异有统计学意义。 结论 经皮空心螺钉治疗第五跖骨基底部撕脱骨折愈合时间短，骨折愈合佳，功能恢复良好，但部分患者存在腓肠神经刺激症状。

    [关键词] 第五跖骨；撕脱骨折；手术治疗；保守治疗

    [中图分类号] R683.420.5[文献标识码] A[文章编号] 1673-7210(2014)05(c)-0007-03

    Comparing efficacy of percutaneous screw fixation and conservative treatment for the fifth metatarsal base avulsion fractures

    LI Jia ZHANG Wei HAO Ming LIANG Xiangdang ZHANG Lihai TANG Peifu▲

    Department of Orthopaedics, General Hospital of PLA, Beijing 100853, China

    [Abstract] Objective To compare the curative effect of percutaneous screw fixation and conservative treatment for the fifth metatarsal base avulsion fractures. Methods From January 2007 to December 2010, 52 cases with the fifth metatarsal base avulsion fractures were selected. 34 patients were treated with percutaneous screw fixation (percutaneous screw fixation group), 18 patients were treated with conservative treatment (conservative treatment group). The bone healing time and outcomes (function scores and pain score) between the two groups were compared. Results All the 52 patients were followed up for 12 to 36 months, with an mean duration of 18 months. In the percutaneous screw fixation group, the fracture healing time was (10.2±2.3) weeks, the average score of the forefoot and midfoot scale (AOFAS) was (92.3±4.2) points, the average score of VAS was (0.9±0.4) points. In the conservative treatment group, the fracture healing time was (12.2±1.2) weeks, the average score of AOFAS was (89.0±3.2) points, the average score of VAS was (1.2±0.4) points. The fracture healing time (P=0.012) and the average scores of AOFAS (P=0.005) in the percutaneous screw fixation group were better than the conservative treatment group, with statistically significant differences. Conclusion Percutaneous screw fixation treatment for the fifth metatarsal base avulsion fractures has less fracture healing time, better effects and functional recovery, but some patients have sural nerve irritation. ......