闭合复位经皮内固定治疗低能量Lisfranc损伤的临床疗效  

Efficacy of close reduction and percutaneous internal fixation for low-energy Lisfranc injuries

作　　者：张明珠 王智[1] 曲峰 魏芳远[1] 张树[1] 孙超[1] 王显军[1] 张建中[1] 俞光荣 ZHANG Mingzhu;WANG Zhi;QU Feng;WEI Fangyuan;ZHANG Shu;SUN Chao;WANG Xianjun;ZHANG Jianzhong;YU Guangrong(Center of Foot and Ankle,Beijing Tongren Hospital of Capital Medical University,Beijing 100005;Department of Foot and Ankle,Tongji Hospital of Tongji University,Shanghai 200065,China)

机构地区：[1]首都医科大学附属北京同仁医院足踝外科中心,北京100005 [2]上海同济医院足踝外科,上海200065

出　　处：《中华骨与关节外科杂志》2020年第9期757-760,共4页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然基金项目(81773091)。

摘　　要：背景:Lisfranc损伤治疗多采用切开复位内固定,也可以采用闭合复位内固定。目的:探讨闭合复位经皮内固定治疗低能量Lisfranc损伤的临床疗效及并发症情况。方法:回顾性分析2010年1月至2018年1月采用闭合复位经皮内固定治疗18例低能量Lisfranc损伤患者的临床资料,男12例,女6例;年龄22~83岁,平均(41.2±6.3)岁。患者受伤至手术时间为2~7 d,平均(3.7±1.6)d。使用3.5 mm实心螺钉固定内侧柱和中间柱,使用克氏针固定外侧柱。采用美国足踝外科协会(AOFAS)中足评分、患者简明健康量表(SF-36)评分和视觉模拟评分(VAS)评估临床疗效,随访观察临床结果和并发症情况。结果:18例的随访时间为18~48个月,平均(27.4±4.6)个月。术后切口均甲级愈合,无伤口并发症,无神经损伤和血管损伤。末次随访的AOFAS中足评分(80.3±5.9)分,VAS评分为(2.1±0.4)分,SF-36的生理功能评分为(82.4±6.8)分,SF-36的躯体疼痛评分为(85.7±7.9)分。末次随访时2例发生内固定物松动或断裂,均无症状,其中1例患者要求取出螺钉,1例未行处理;1例发生跖跗关节创伤性关节炎,但无症状,未行处理。结论:低能量Lisfranc损伤可以采用闭合复位经皮内固定进行治疗,临床疗效可靠。Background:Open reduction and internal fixation is often taken for Lisfranc injury,while close reduction and internal fixation is also one treatment measure.Objective:To investigate the effect of close reduction and percutaneous internal fixation for low-energy Lisfranc injury and its complications.Methods:From January 2010 to January 2018,18 patients with low-energy Lisfranc injuries undergoing close reduction and percutaneous internal fixation were selected including 12 males and 6 females with a mean age of(41.2±6.3)years(range,22-83).The time from injury to surgery was(3.7±1.6)days(range,2-7).Medial and middle columns were fixed with 3.5 mm solid screws.Lateral column was fixed with K-wires.Clinical efficacy was evaluated by AOFAS midfoot scores,visual analogue scale(VAS)and SF-36 scores.Outcomes and complications were analyzed as well.Results:All patients were followed up for 18-48 months with an average of(27.4±4.6)months.Incisions were all healed to class A.No incision complications and no nerve and vascular injury were found.At final follow-up,the mean AOFAS midfoot score was(80.3±5.9);the mean VAS score was(2.1±0.4);the body pain score of SF-36 was(85.7±7.9).Two patients had loosen or broken internal fixator without any symptoms,of whom one had the screw out and one took no measure.One patient had traumatic arthritis of tarsometatarsal joint without any symptoms taking no measures.Conclusions:Close reduction and percutaneous internal fixation is effective and feasible for low-energy Lisfranc injury.

关 键 词：足损伤 骨折固定术 内 跖跗关节不稳 

分 类 号：R687.3[医药卫生—骨科学]