切开复位内固定与Ⅰ期融合治疗伴第一跖跗关节脱位Lisfranc损伤的疗效比较  

Effect comparison between open reduction internal fixation and primary arthrodesis for treatmentof Lisfranc injuries combined with first tarsal joint dislocation

作　　者：张明珠[1] 杨云峰[1] 苗旭东[2] 徐海林[3] 黄建华[4] 张洪涛[5] 张晖[6] 王志坚[7] 杨茂伟[8] 栾波 阿发武 俞光荣[1] Zhang Mingzhu;Yang Yunfeng;Miao Xudong;Xu Hailin;Huang Jianhua;Zhang Hongtao;Zhang Hui;Wang Zhijian;Yang Maowei;Luan Bo;A Fawu;Yu Guangrong(Department of Foot and Ankle Surgery,Tongji Hospital of Tongfi University,Shanghai 200065,Chin)

机构地区：[1]同济大学附属同济医院足踝外科,上海200065 [2]浙江大学附属第二医院骨科 [3]北京大学人民医院骨科 [4]上海市第一人民医院骨科 [5]苏州大学附属第一医院创伤骨科 [6]四川大学附属华西医院骨科 [7]大连市第三人民医院骨科 [8]中国医科大学附属第一医院骨科 [9]贵阳市骨科医院

出　　处：《中华创伤杂志》2018年第7期585-590,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金（81401782,81472144,81773091）

摘　　要：目的探讨切开复位内固定与Ⅰ期融合治疗伴第一跖跗关节脱位Lisfranc损伤的临床疗效。方法采用回顾性病例对照研究分析2009年1月-2015年6月全国9个足踝外科中心具有完整随访资料的126例伴第一跖跗关节脱位Lisfranc损伤患者临床资料，其中男76例（60．3％），女50例（39．7％）；年龄20—87岁，平均45．5岁。单纯脱位41例（32．5％），骨折脱位85例（67．5％）。受伤至手术时间为4～26d，平均11．7d。根据手术方式分为切开复位内固定组（92例）和Ⅰ期融合组（34例）。比较两组切口愈合情况。采用美国足踝外科协会（AOFAS）中足评分、患者简明健康调查量表（SF-36）评分和视觉模拟评分（VAS）评估疗效；同时随访并发症情况。结果126例患者随访18～80个月，平均29．5个月。术后切口均Ⅰ期愈合。末次随访时AOFAS中足评分：切开复位内固定组与Ⅰ期融合组分别为（79．4±6．7）分和（85．1±8．3）分（P〈0．05）；VAS分别为（3．1±0．6）分和（2．2±0．3）分（P〈0．05）；SF-36的生理功能评分为（80．3±5．3）分和（83．5±6．9）分（P〉0．05）；SF-36的躯体疼痛评分为（76．1±4．6）分和（84．6±8．7）分（P〈0．05）。切开复位内固定组有5例（5％）发生内固定物松动或断裂，16例（17％）再次脱位，36例（39％）行走时中足疼痛较明显，8例（6％）发生跖跗关节创伤性关节炎，并行Ⅱ期融合术；Ⅰ期融合组有2例（6％）内固定引起疼痛，取出内固定后好转，未见再次脱位、内固定松动断裂或创伤性关节炎（P〈0．05）。结论对于伴第一跖跗关节脱位Lisfranc损伤，Ⅰ期行第一跖跗关节融合术稳定第一跖跗关节，可以改善患足功能，减轻疼痛，避免发生再次脱位、疼痛、内固定失败或二次手术等并发症和不良后果。Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal jointdislocation. Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015. There were 76 males （60.3%） and 50 females （39.7%） with an average age of 45.5 years （range, 20-87 years）. Among the 126 cases, simple dislocation occurred in 41 cases （32.5%）, and fracture dislocation in 85 cases （67.5%）. The duration from injury to surgery was ll. 7 days （range, 4-26 days）. According to surgery method, the patients were divided into open reduction internal fixation group （n = 92 ） and primary arthrodesis group （n = 34 ）. The outcomes were evaluated by American Orthopedic Foot and Ankle Society（AOFAS） score, 36-items short form health survey （SF-36）, and visual analogue score （VAS）. Complications were also followed up. Results All patients were followed up for 18-80 months, with an average of 29.5 months. Primary union was seen in all the patients. At the last follow up, the mean AOFAS midfoot score was （79.4± 6.7 ） points in open reduction and internal fixation group and （ 85.1 ±8.3 ） points in primary arthrodesis group （ P 〈 0.05 ）. The mean VAS was （ 3. 1± 0.6 ） points in open reduction and internal fixation group and （2.2 ± 0.3 ）points in primary arthrodesis group （P 〈 0.05 ）. The physiological function of SF-36 was （ 80.3 ± 5.3） points in open reduction and internal fixation group and （ 83.5 ± 6.9） points in primary arthrodesis group （ P 〉 0.05 ）. The body pain score of SF-36 was （76.1 ± 4.6 ） points in open reduction and internal fixation group and （ 84.6 ± 8.7 ） points in primary arthrodesis group （P 〈 0. 05）. In open reduction

关 键 词：足损伤 骨折固定术  内 关节融合术 

分 类 号：R687.4[医药卫生—骨科学]