切开复位内固定治疗Lisfranc损伤  

Efficacy of open reduction and internal fixation in the treatment of Lisfranc injury

作　　者：林昊[1,2,3,4] 蔡鸿儒 高翔[1,2,3,4] 许志贤 柯铁[1,2,3,4] 张旭鸣 LIN Hao;CAI Hong-ru;GAO Xiang;XU Zhi-xian;KE Tie;ZHANG Xu-ming(Department of Emergency Surgery,Fujian Provincial Hospital,Fuzhou,Fujian 350001,China;Shengli Clinical Medical College,Fujian Medical University,Fuzhou 350001,China;Fujian Provincial Institute of Emergency Medicine,Fuzhou 350001,China;Fujian Emergency Center,Fuzhou 350001,China)

机构地区：[1]福建省立医院急诊外科,福州350001 [2]福建医科大学省立临床医学院,福州350001 [3]福建省急诊医学研究所,福州350001 [4]福建省急救中心,福州350001

出　　处：《创伤与急诊电子杂志》2019年第4期191-194,共4页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨使用微型钢板和空心螺钉切开复位内固定治疗Lisfranc损伤的临床疗效。方法回顾性分析福建省立医院2013年6月至2017年8月收治的11例Lisfranc损伤患者,均采用切开复位内固定(微型钢板或空心螺钉)治疗,其中男性7例,女性4例,根据AO分型:A型2例,B型5例,C型4例。所有损伤均为闭合性且无颅脑外伤及其他合并伤,在伤后7~14d(平均8.8d)手术,术前、术后功能评价采用视觉模拟评分法(visual analogue scale,VAS)及美国足踝矫形学会(American Orthopedic Foot and Ankle Society,AOFAS)的踝-后足功能评分量表。结果所有患者均获得14~26个月的随访(平均21.2个月),复查足正斜位X线片均提示获得解剖复位,术后8周患者VAS评分为(0.74±0.21)分低于术前(8.12±0.46)分,差异有统计学意义(t=4.019,P<0.05)。按照AOFAS评分,术后12个月优4例,良5例,一般2例,优良率为81.82%,高于术前良3例,一般6例,差2例,优良率27.27%,差异有统计学意义(χ2=5.95,P<0.05)。随访期间均未出现伤口感染,2例出现创伤性关节炎。结论使用微型钢板或空心螺钉切开复位内固定治疗Lisfranc损伤能够获得解剖复位并重建正常的Lisfranc关节结构及修复损伤的韧带。此种治疗方式能够取得良好的治疗效果,避免术后并发症并显著提高患者生活质量。Objective To investigate the efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury.Methods Eleven cases of Lisfranc injury treated by open reduction with miniplate or hollow screw in our department between June,2013 and August,2017 were retrospectively analyzed.There were 7 males and 4 females.Among them,2 cases were classified as type A,5 classified as type B and 4 classified as type C.All injuries were closed without cerebral trauma or other complicated injuries.The time interval between injury and operation was 7~14 days(mean 8.8 days),postoperatively.The foot function was assessed using visual analogue scales(VAS)and American Orthopaedic Foot and Ankle Society(AOFAS)scales.Results All patients were followed up for 14~26 months(mean 21.2months).Anatomic reduction was achieved in all patients on images.The VAS score of patients 8 weeks after operation was significantly lower than that before operation(0.74±0.21 vs 8.12±0.46,t=4.019,P<0.05).According to the AOFAS scales,4 cases were defined as excellent,5 cases as good and 2 cases as fair 12 months after operation.The rate of excellent and good outcomes was 81.82%postoperatively,which was higher than 27.27%preoperatively.The difference was statistically significant(χ2=5.95,P<0.05).There was no wound infection during follow-up except for 2 cases of osteoarthritis.Conclusion Open reduction and internal fixation with the miniplate and hollow screw contributes to achieving anatomical reduction of Lisfranc injury,regaining normal structure of Lisfranc joint and repairing injured ligaments.This method offers excellent curative effect,avoid postoperative complications and improve the quality of patients’life.

关 键 词：LISFRANC损伤 切开复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]