复位内固定术与关节融合术治疗Lisfranc关节急性损伤的疗效比较  

Comparison treatment of efficacy of acute lisfranc joint injury by primary arthrodesis and by reduction and internal fixation

作　　者：杨衡[1] 鲁小波[1] 叶俊武[1] 

机构地区：[1]泸州医学院附属医院骨关节科,四川泸州646000

出　　处：《泸州医学院学报》2015年第2期163-166,共4页Journal of Luzhou Medical College

摘　　要：目的：评价复位内固定术与关节融合术治疗Lisfranc关节急性损伤的疗效比较。方法：自2006年1月至2012年6月，按照纳入及排除标准选取35例患者纳入研究，复位内固定组（RIF组）17例，关节融合组（JF组）18例，随访均超过2年。采用VAS、AOFAS调查问卷方法进行疗效评估，采用X线片进行影像学评估足关节炎、复位、骨愈合等情况。结果：35例患者均获得门诊随访，平均随访27.5个月（25~35个月），与RIF组患者比较，JF组患者在术后3、6、12、24个月的VAS评分均有明显降低，在术后6、12、24个月的AOFAS评分均有明显增加（P〈0.05）。两组患者在满意度比较，JR组满意度优良率高达94%，RIF组满意度仅达65%，5例（29%）患者行关节融合治疗。结论：Lisfranc关节急性损伤患者一期行关节融合术的疗效确切，尤其适用于Lisfranc关节内侧柱及中柱严重骨折脱位或单纯韧带损伤患者，具有并发症发生率低、满意度高等优势，是治疗Lisfranc关节损伤安全、有效的手术方式。Objective： To compare the therapentic effect of primary arthrodesis with reduction and internal fixation in the treatment of acute Lisfranc joint injury. Methods： Thirty-five patients with acute Lisfranc joint injury were enrolled in retrospective study. Seventeen patients were treated with open reduction and internal fixation, and eighteen patients were treated with primary arthrodesis. The patients were followed-up for an average of 42.5 months. Evaluation was performed by clinical examination, radiography, the American Orthopaedic Foot and Ankle Society （AOFAS） Midfoot Scale, Visual Analog pain Scale （VAS）, and a clinical questionnaire. Results： Two years postoperation, the mean AOFAS Midfoot score was 82.9 points in the open-reduction group and 89.8 points in the arthrodesis group （P〈 0.005）. Five patients in the open-reduction group had persistent pain with the development of deformity or osteoarthrosis, and they were eventually treated with arthrodesis. The patients who had been treated with primary arthrodesis their postoperative degree of satisfaction was 94%, whereas in open-reduction group the satisfaction degree was only 65% （P 〈 0.005）. Conclusions： Primary arthrodesis appears to have a better outcome than open reduction and internal fixation in treating Lisfranc joint injuries.

关 键 词：Lisfranc骨折脱位 内固定 融合 疗效 

分 类 号：R699.8[医药卫生—泌尿科学]