切开复位内固定术治疗骰骨压缩性骨折外侧柱Lisfranc损伤的临床疗效及并发症影响因素分析  

Open reduction and internal fixation for the treatment of lateral column Lisfranc injuries combined with cuboid compressibility fractures and risk factors for complications

作　　者：鲍沁蔚 李茂林 巫宗德 刘亮[1] 魏国华[1] 彭亮[1] 刘峻宏 张强[1] Bao Qinwei;Li Maolin;Wu Zongde;Liu Liang;Wei Guohua;Peng Liang;Liu Junhong;Zhang Qiang(Department of Foot and Ankle Traumatology,Sichuan Orthopaedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省骨科医院足踝创伤科,成都610041

出　　处：《创伤外科杂志》2023年第8期608-613,共6页Journal of Traumatic Surgery

基　　金：四川省干部保健科研课题(川干研2021-604)。

摘　　要：目的探究切开复位内固定术对合并骰骨压缩性骨折外侧柱Lisfranc损伤的治疗效果,分析术后并发症的影响因素。方法前瞻性选择笔者医院2016年3月—2021年8月收治的合并骰骨压缩骨折的外侧柱Lisfranc损伤患者108例,其中男性72例,女性36例;年龄18~78岁,平均42.4岁;致伤原因:道路交通伤42例,挤压伤26例,跌落伤30例,其他10例。待患者软组织条件达标后择期行切开复位微型钢板及螺钉内固定手术治疗。对患者进行术后3、6个月及1年门诊随访,评估患者复位效果。采用美国足踝外科协会踝与后足功能(American Orthopaedic Foot&Ankle Society,AOFAS)评分、疼痛视觉模拟评分(visual analogue scale,VAS)评估患者恢复情况。记录患者术后1年内出现创伤性关节炎、功能受限、感染、肿胀、切口不愈合等并发症发生率。根据术后1年是否出现并发症分为无并发症组和并发症组,结合患者临床资料分析并发症影响因素。结果87例术后3个月被评估为解剖复位,17例被评估为近解剖复位,4例被评估为非解剖复位。与治疗前相比[力线(5.11±1.16)分、功能(19.37±4.12)分、疼痛(18.42±4.14)分以及AOFAS总分(42.90±8.14)分],治疗后[力线(13.48±1.30)分、功能(36.36±4.99)分、疼痛(32.56±5.26)分以及AOFAS总分(82.40±9.48)分]均有明显升高,差异有统计学意义(P<0.05)。术后VAS(3.32±0.84)分低于术前[(7.28±1.66)分,P<0.05]。术后1年,18例患者出现并发症,并发症发生率为16.67%。并发症组年龄、饮酒、糖尿病、受伤至入院时间、Quenu-Kuss分型与无并发症组比较差异有统计学意义(P<0.05)。Logistic回归分析显示年龄、饮酒、糖尿病、Quenu-Kuss分型是术后并发症发生的独立危险因素(P<0.05)。结论切开复位内固定对于合并骰骨压缩性骨折的Lisfranc损伤有较好的治疗效果,年龄、饮酒、糖尿病、Quenu-Kuss分型是术后出现并发症的主要影响因素。Objective To explore the therapeutic effect of open reduction and internal fixation on Lisfranc injuries of the lateral column combined with cuboid compression fractures,and to analyze the influencing factors of postoperative complications.Methods A total of 108 patients with Lisfranc injuries of the lateral column combined with cuboid compression fractures were prospectively selected from our hospital between Mar.2016 and Aug.2021,including 72 male and 36 female aged 18-78 years,mean 42.4 years.The injury causes were road traffic accidents in 42 patients,crush injuries in 26,falls in 30 and others in 10.After the soft tissue conditions of patients reached the required standard,open reduction and internal fixation was performed.Patients were followed up at 3,6 months and 1 year after operation when the reduction level was evaluated.The ankle and hind foot function score by the American Orthopaedic Foot&Ankle Society(AOFAS)and pain by visual analogue scale(VAS)of were used to evaluate the recovery of patients.The incidence of traumatic arthritis,functional limitation,muscle atrophy,internal fixation failure,infection and other complications were recorded within 1 year after operation.Then patients were divided into complication group and non-complication group,to further explore the risk factors for the incidence of complications.Results Among the 108 patients,87(80.56%)were evaluated as anatomical reduction,17(15.74%)as near anatomical reduction,and 4(3.70%)as non-anatomical reduction at 3 months after surgery.Compared with before surgery,open reduction and internal fixation significantly improved the AOFAS scores,respectively in terms of force line(5.11±1.16 vs.13.48±1.30),function(19.37±4.12 vs.36.36±4.99),pain(18.42±4.14 vs.32.56±5.26)and total score(42.90±8.14 vs.82.40±9.48)and the differences were significant(all P<0.05).The VAS significantly decreased after operation(7.28±1.66 vs.3.32±0.84,P<0.05).Within one year follow-up,18 patients developed complications,with the incidence being 16.67%.Compari

关 键 词：骰骨压缩性骨折 内固定 LISFRANC损伤 疗效 并发症 

分 类 号：R683.42[医药卫生—骨科学]