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          当前位置:首页-->疾病诊断-->跖骨骨折

          跖骨骨折
           
           
           分类
           中文名称
           概述
           辅助检查
           治疗方案及原则
           病程和预后
           最新进展和展望
           诊断标准  
           
           诊断依据
           参考文献
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           分类
            创伤及骨科学  
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           中文名称
            跖骨骨折  
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            概述
              跖骨骨折是足部较常见的骨折,由于第1跖骨最粗大,发生骨折的机会相对较少,第2~4跖骨发生骨折的机会相对较多,第5跖骨基底部由于是松质骨,多因腓骨短肌的猛烈收缩而发生撕脱性骨折跖骨骨折多为重物打击足背、碾压足部及足内翻扭伤引起,少数情况下,由于长期积累性劳损而致第2或第3跖骨干的疲劳性骨折
          诊断思路
              1.病史要点 有明确的足部外伤史,伤后足部肿胀疼痛、淤血、瘀斑。 
              2.查体要点 局部压痛、纵向叩击痛,足部的短缩畸形,负重时疼痛加重,不能行走。 
           
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            辅助检查
              足的正位、侧位和斜位X线检查是必需的,以明确骨折的部位和移位的程度。
           
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           治疗方案及原则
            治疗
              1.保守治疗 大多数的跖骨骨折可采用非手术治疗,尤其是第l和第5跖骨骨折的治疗更是如此。对于无移位的跖骨骨折,用短腿石膏固定4~6周,对于有移位的跖骨骨折,可行手法复位,复位后仍可用石膏固定,须注意足弓的塑形。
              2.手术治疗 如手法整复失败,则应手术切开复位内固定,内固定方法包括克氏针内固定、小型接骨板螺钉固定、克氏针横行固定于邻近的跖骨等。治疗上应力求恢复解剖轴线,多发性骨折往往足部肿胀严重,单纯采用抬高患肢的方法不能缓解肿胀时,应及时进行足背横韧带及深筋膜的切开减压。
           
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           病程和预后
            预后评价
              跖骨骨折在足部骨折中较为常见,暴力容易造成第2~4跖骨的螺旋形骨折或第5跖骨基底部的撕脱性骨折,重物砸伤可致任何部位的跖骨骨折。一般预后良好,但跖骨干的横形骨折,不愈合率可达67%。
           
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           最新进展和展望
            最新进展
              负重试验表明,重力的分布在前足有6个负重接触点,第 1跖骨(2个籽骨)承担了1/3 的载荷,第 2、3、4、5跖骨各承担1/6的载荷,治疗的重点在于保持前足重力分布的对称性。
           
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            诊断标准 
              (1)有足部外伤史,中足的疼痛肿胀
              (2)局部压痛、纵向叩击痛,足部畸形,负重时疼痛加重。
              (3)X线检查可明确骨折。 
          诊断流程
              诊断流程(图4—74)
           
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           诊断依据
            骨科疾病诊断流程与治疗策略  
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            参考文献
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          范卫民,陶松年,王道新等.1997.双颈滑动加压螺钉设计及转子间骨折治疗.中华创伤杂志,13(2):96~98
          李京生,马秀生,刘树清.2001.经内踝截骨人路可吸收材料固定治疗距骨矢状面骨折.中国矫形外科杂志,8(6):539
          王亦璁.2001.骨与关节损伤.第3版.北京:人民卫生出版社
          吴乃庆,宋李军,王道新等.1997.鱼口交锁髓内钉和其他三种交锁髓内钉的生物力学性能比较.中华骨科杂志,17(4):233
          胥少汀,葛宝丰,徐印坎.2005.第3版.实用骨科学.北京:人民军医出版社
          许晓倩,张秋林,王秋根.2004.距骨骨折治疗的研究进展.中国矫形外科杂志,12(3、4):288~290
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