第三跖跗关节间接固定在高能量Lisfranc损伤中的应用  

Indirect fixation of the third tarsometatarsal joint for high-energy Lisfranc injury

作　　者：夏江[1] 李兵[1] 周海超[1] 于涛[1] 俞光荣[1] 杨云峰[1] XIA Jiang;LI Bing;ZHOU Haichao;YU Tao;YU Guangrong;YANG Yunfeng(Department of Orthopedics,Tongji Hospital,Tongji University,Shanghai,200065,P.R.China)

机构地区：[1]同济大学附属上海市同济医院骨科,上海200065

出　　处：《中国修复重建外科杂志》2021年第4期426-430,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金青年基金资助项目(81472144、31800782)。

摘　　要：目的探讨高能量Lisfranc损伤中第3跖跗关节间接固定对临床疗效的影响。方法 2015年2月—2019年2月,收治15例高能量Lisfranc损伤患者。男12例,女3例;年龄29~73岁,平均44.8岁。受伤至入院时间为2~28 h,平均8.8 h。根据Myerson分型标准:A型6例、B2型4例、C1型1例、C2型4例。开放损伤8例。影像学检查示患者第3跖跗关节均受累;跖骨间韧带完整7例,第2、3跖骨间韧带损伤6例,第3、4跖骨间韧带损伤1例,第2、3以及第3、4跖骨间韧带损伤1例。13例术中未行第3跖跗关节固定,仅通过固定第2、4跖跗关节来间接固定;1例跖骨间韧带损伤严重,1例第3跖骨基底部粉碎性骨折,通过克氏针固定第3跖跗关节。术后X线片复查评估骨折脱位复位情况,判断第3跖跗关节有无再移位。采用美国矫形足踝协会(AOFAS)评分以及疼痛视觉模拟评分(VAS)评价足部功能及疼痛情况。结果术后13例患者获随访,随访时间12~26个月,平均15.6个月。1例切口浅表感染,对症处理后愈合;其余患者切口均Ⅰ期愈合。末次随访时,患者VAS评分为0~3分,平均1.1分;AOFAS评分为70~99分,平均87.5分。影像学复查示,12例跖跗关节达解剖复位,1例距骨第1跖骨角增大,出现轻度前足外展;第3跖跗关节随访期间复位无丢失,末次随访时2例发生自发性融合。结论高能量Lisfranc损伤患者只要跖骨间韧带和跖跗关节骨性结构未完全破坏,第3跖跗关节的稳定性可以通过固定邻近跖跗关节来获得,无需常规固定。Objective To evaluate the effectiveness of indirect fixation of the 3rd tarsometatarsal joint in the treatment of high-energy Lisfranc injury. Methods Between February 2015 and February 2019, 15 patients with highenergy Lisfranc injury were treated. There were 12 males and 3 females with an average age of 44.8 years(range, 29-73 years). The average time from injury to admission was 8.8 hours(range, 2-28 hours). According to Myerson classification,there were 6 cases of type A, 4 cases of type B2, 1 case of type C1, and 4 cases of type C2;8 cases were open injury. The 3rd tarsometatarsal joint was injured in all patients, including intact intermetatarsal ligament in 7 cases, the 2nd-3rd intermetatarsal ligament injury in 6 cases, the 3rd-4th intermetatarsal ligament injury in 1 case, and the 2nd-3rd-4th intermetatarsal ligament injury in 1 case. Among them, the 3rd tarsometatarsal joint was not fixed directly and indirectly fixed by stabilized the 2nd and 4th tarsometatarsal joints in 13 cases. The 3rd tarsometatarsal joint was fixed with Kirschner wire in 2 cases for 1 patient had complete injury of the intermetatarsal ligament and the other 1 had comminuted fracture of the base of the 3rd metatarsal. The reduction of fracture and dislocation was evaluated by X-ray films, focusing on the re-displacement of the 3rd tarsometatarsal joint. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society(AOFAS) score and visual analogue scale(VAS) score. Results Thirteen of the 15 patients were followed up 12-26 months, with an average of 15.6 months. One case had superficial infection of the incision and healed after symptomatic treatment;the other incisions healed by first intention. At last follow-up, the VAS score was 0-3(mean, 1.1) and the AOFAS score was 70-99(mean, 87.5). Twelve patients achieved anatomical reduction and 1 patient had increased talar-first metatarsal angle and the mild forefoot abduction. During the follow-up, no loss of reduction of the 3rd tarsometatarsal joint was found, while

关 键 词：LISFRANC损伤 高能量损伤 内固定 第3跖跗关节 跖骨间韧带 

分 类 号：R687.4[医药卫生—骨科学]