合并跖骨远端骨折的Lisfranc损伤的手术治疗  

Surgical management of Lisfranc injury with distal metatarsal fractures

作　　者：顾文奇[1] 王诚 宋国勋 傅绍菱 王嘉正 吴承霖 张解元 邹剑[1] 薛剑锋[1] 苏琰[1] 梅国华[1] 施忠民[1] GU Wenqi;WANG Cheng;SONG Guoxun;FU Shaoling;WANG Jiazheng;WU Chenglin;ZHANG Jieyuan;ZOU Jian;XUE Jianfeng;SU Yan;MEI Guohua;SHI Zhongmin(Department of Orthopaedics,Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《中华骨与关节外科杂志》2023年第12期1079-1084,共6页Chinese Journal of Bone and Joint Surgery

基　　金：上海市“科技创新行动计划”生物医药领域科技支撑项目(22S31900800);上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD018)。

摘　　要：目的:探讨合并跖骨远端骨折的Lisfranc损伤的手术方法及疗效。方法:回顾性分析2016年1月至2020年12月收治的15例合并跖骨远端骨折的Lisfranc损伤患者,其中男9例,女6例,年龄24~70岁,平均44.3岁。根据Chiodo-Myerson三柱分型理论,双柱损伤9例,三柱损伤6例。跖骨远端受累情况:3例单纯第2跖骨远端骨折,其余均为多发跖骨远端骨折(第2、3跖骨远端骨折8例,第2~4跖骨远端骨折4例)。对于软组织条件不佳者采取分期治疗策略。所有患者均在软组织条件改善后行切开复位内固定术。结果:3例患者采取分期治疗策略。2例出现早期伤口愈合不良,经换药后伤口愈合。所有患者随访12~48个月,平均25.2个月;术后3个月影像学随访均证实骨性愈合。Maryland足部评分为63~93分,平均76.9分;疼痛视觉模拟评分(VAS)0~4分,平均1.5分。11例患者存在不同程度的受累跖趾关节活动受限,4例表现为跖趾关节僵硬。随访期间未见骨不连、畸形愈合、内固定失效及创伤性关节炎等并发症。结论:对于合并跖骨远端骨折的Lisfranc损伤,术前需仔细评估软组织条件,必要时需分期治疗。切开复位内固定是治疗此类损伤的有效方法,关键在于解剖重建中前足力线,获得稳定的固定及早期康复。Objective:To discuss the technique and clinical outcome of surgical treatment for Lisfranc injury with distal metatarsal fractures.Methods:A retrospective study was conducted on 15 cases of Lisfranc injury with distal metatarsal fractures treated at the Department of Orthopaedics,Shanghai Sixth People's Hospital from January 2016 to December 2020.There were 9 men and 6 women,with an average age of 44.3 years(from 24 to 70 years).According to the Chiodo-Myerson classification system,9 cases were categorized as two-column injury,and others were the three-column injury.For the distal metatarsal fractures,three cases presented with an isolated distal 2nd metatarsal fracture,eight cases were 2nd and 3rd metatarsal fractures,and another four cases had the 2nd to 4th metatarsal fractures.The patients with poor soft tissue conditions were managed with a staged strategy.The definitive open reduction and internal fixation was not applied in all cases until their soft tissue condition was improved.Results:Three cases underwent a staged treatment.Two patients experienced early wound healing complications,which were resolved after dressing changes.All cases were followed for an average of 25.2 months(from 12 to 48 months).The X-ray at 3rd months follow-up demonstrated successful bone union.Their post-operative Maryland foot scores ranged from 63 to 93 with an average of 76.9.Visual analogue scale scores ranged from 0 to 4 with an average of 1.5.Eleven cases suffered from the limited range of motion of involved MTPJ,four of which had the rigid joint.No complications such as nonunion,malunion,implant failure,or post-traumatic arthritis occurred during the follow-up period.Conclusions:For Lisfranc injury with distal metatarsal fractures,the soft tissue condition should be carefully evaluated pre-operatively and a staged strategy may be needed when necessary.Open reduction and internal fixation is an effective approach for treating this pattern of injury.Anatomical restoration of the midfoot and forefoot alignment with a stable f

关 键 词：跖骨 足关节 骨折 脱位 骨折固定术 内 

分 类 号：R683.4[医药卫生—骨科学]