Lisfranc关节损伤预后的影响因素分析  

Analysis of Influencing Factors for Prognosis of Lisfranc Joint Injury

作　　者：李兵[1] 朱云[1] 尹刚 冯杰 施剑烽 季本亮 夏港俊 陆林华 LI Bing;ZHU Yun;YIN Gang;FENG Jie;SHI Jianfeng;JI Benliang;XIA Gangjun;LU Linhua(Department of Hand and Foot Surgery,the People′s Hospital of SND,Suzhou 215129,China;Department of Orthopedics,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]苏州高新区人民医院手足外科,江苏苏州215129 [2]上海市第一人民医院骨科,上海200080

出　　处：《医学综述》2020年第15期3107-3110,3116,共5页Medical Recapitulate

摘　　要：目的分析切开复位内固定术(ORIF)治疗Lisfranc关节损伤预后的影响因素。方法收集2006年1月至2018年12月苏州高新区人民医院收治的395例Lisfranc关节损伤患者的临床资料进行回顾性分析,患者均接受ORIF,根据术后3个月足部功能恢复情况采用美国足踝矫形外科协会中足评分系统评价其预后,将评分在优、良范围内的347例患者纳入预后良好组,评分在可、差范围内的48例患者纳入预后不良组。记录患者的一般资料(性别、年龄、受伤原因、受伤至入院时间、足部手术史等)、Lisfranc损伤分型及内固定方式(克氏针、全螺纹皮质骨螺丝钉、小钢板及外压固定)等。通过单因素与多因素Logistic分析Lisfranc关节损伤预后的影响因素。结果预后不良组年龄≥45岁、受伤至入院时间≥24 h、损伤分型C型及克氏针内固定方式患者的所占比例均高于预后良好组[83.33%(40/48)比39.19%(136/347),66.67%(32/48)比38.04%(132/347),50.00%(24/48)比6.34%(22/347),66.67%(32/48)比10.95%(38/347)](P<0.05)。经非条件多因素Logistic回归分析结果显示,中老年、受伤至入院时间、损伤分型及内固定方式均可能是Lisfranc关节损伤预后不良的影响因素(P<0.05)。结论年龄、受伤至入院时间、损伤分型及内固定方式可能是ORIF治疗Lisfranc关节损伤患者预后不良的影响因素,临床应针对上述影响因素制订针对性措施,避免危险因素对预后的影响,以改善Lisfranc关节损伤患者预后。Objective To analyze the influencing factors of prognosis of open reduction and internal fixation(ORIF)in treatment of Lisfranc joint injury.Methods The clinical data of 395 patients with Lisfranc joint injury admitted to the People′s Hospital of SND from Jan.2006 to Dec.2018 were retrospectively analyzed,all of which underwent ORIF.According to the recovery of foot function at 3 months after surgery assessed by the American Orthopedic Foot and Ankle Society-Midfoot Score,the prognosis was evaluated.347 cases with excellent score were included in a good prognosis group,and 48 cases with poor score were included in a poor prognosis group.The general data(gender,age,cause of injury,time of injury to admission,history of foot surgery,etc.),Lisfranc injury classification,internal fixation methods(Kirschner wire,full-thread cortical bone screw,small steel plate and external pressure fixation)of the patients were recorded.Univariate and multivariate analysis were used to identify the influencing factors of the prognosis of Lisfranc joint injury.Results The proportion of patients≥45 years old,injury to hospital time≥24 hours,injury type C and Kirschner wire internal fixation in the poor prognosis group were higher than those in the good prognosis group[83.33%(40/48)vs 39.19%(136/347),66.67%(32/48)vs 38.04%(132/347),50.00%(24/48)vs 6.34%(22/347),66.67%(32/48)vs 10.95%(38/347)](P<0.05).Unconditional multivariate Logistic analysis showed that middle and old age,time of injury to admission,injury classification and internal fixation methods may all be the influencing factors for the poor prognosis of Lisfranc joint injury(P<0.05).Conclusion The age,time of injury to admission,injury classification and internal fixation methods may be the influencing factors for the poor prognosis of ORIF in treatment of Lisfranc joint injury.Therefore,clinical measures should be formulated for the above-mentioned influencing factors to avoid the effect of risk factors on the prognosis,and improve the prognosis of the patients.

关 键 词：LISFRANC关节损伤 切开复位内固定术 预后 影响因素 

分 类 号：R687.3[医药卫生—骨科学]