Tightrope弹性固定与Lisfranc螺钉固定治疗韧带损伤型Myerson B2型跖跗关节损伤的中期随访比较研究  

Flexible Tightrope versus rigid Lisfranc screw fixation for ligamentous Myerson type B2 Lisfranc injury:a mid-term analysis

作　　者：薛剑锋[1] 顾文奇[1] 王诚 宋国勋 傅绍菱 王嘉正 吴承霖 张解元 梅国华[1] 苏琰[1] 邹剑[1] 施忠民[1] XUE Jianfeng;GU Wenqi;WANG Cheng;SONG Guoxun;FU Shaoling;WANG Jiazheng;WU Chenglin;ZHANG Jieyuan;MEI Guohua;SU Yan;ZOU Jian;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》2024年第4期307-313,共7页Chinese Journal of Bone and Joint Surgery

基　　金：上海市“科技创新行动计划”生物医药科技支撑专项项目(22S31900800);上海交通大学多学科交叉项目培育基金(YG2022ZD018)。

摘　　要：目的:比较Tightrope弹性固定与Lisfranc螺钉固定治疗韧带损伤型Myerson B2型跖跗关节损伤的临床疗效。方法:回顾性分析2015年2月至2019年6月收治的28例韧带损伤型MyersonB2型跖跗关节损伤患者的临床资料,根据固定方式的不同分为Lisfranc螺钉固定的螺钉固定组15例,Tightrope弹性固定的弹性固定组13例。采用影像学检查评估关节复位保持情况及有无关节退行性变,使用美国足踝外科协会(AOFAS)中足评分、足部功能指数(FFI)及疼痛视觉模拟评分(VAS)评估临床疗效,记录并发症发生情况。结果:28例患者获得36~75个月随访,平均随访(57.9±11.1)个月,弹性固定组患者术后6个月的AOFAS中足评分、FFI、VAS评分均优于螺钉固定组(P均<0.05),术后1年及末次随访时两组比较差异无统计学意义(P均>0.05)。螺钉固定组中12例(80.0%)患者于术后7~12个月行二次手术取出内固定,平均取出时间为术后(9.8±1.3)个月;弹性固定组中1例患者因锁扣板软组织刺激疼痛于术后12个月行二次手术取出内固定。两组无一例患者发生创伤性关节炎。结论:Tightrope弹性固定治疗韧带损伤型Myerson B2型跖跗关节损伤可获得与Lisfranc螺钉固定相当的临床疗效,术后早期恢复更快,可避免二次手术取出内固定。Objective:To compare the clinical efficacy of flexible Tightrope and rigid Lisfranc screw fixation for ligamentous Myserson type B2 Lisfranc injury.Methods:A retrospective analysis of clinical data from 28 patients with ligamentous Myserson type B2 Lisfranc injury admitted from February 2015 to June 2019 was performed.Patients were divided into two groups based on the different fixation methods:15 cases with traditional Lisfranc screw,and 13 cases with flexible Tightrope.Imaging examination was used to evaluate the maintenance of reduction and the presence of joint degeneration.The American Orthopedic Foot and Ankle Society(AOFAS)midfoot scale,foot function index(FFI),and visual analog scale(VAS)for pain were used to evaluate the clinical outcomes.Complications were recorded.Results:Twenty-eight patients were followed up for 36-75 months,with an average follow-up of(57.9±11.1)months.At 6 months postoperatively,the AOFAS midfoot score,FFI,and VAS scores in patients with Tightrope fixation were significantly better than those with screw fixation(all P<0.05).However,there were no statistically significant differences between the two groups at 1 year postoperatively or the final follow-up(both P>0.05).In the screw fixation group,12 cases(80.0%)underwent secondary surgery for screw removal between 7 and 12 months postoperatively,with an average removal time of(9.8±1.3)months postoperatively.In the flexible fixation group,one case underwent a secondary surgery for removal due to soft tissue irritation caused by the locking plate at 12 months postoperatively.None of the patients in either group developed traumatic arthritis.Conclusions:For ligamentous Myserson type B2 Lisfranc injury,flexible Tightrope fixation can achieve clinical outcomes comparable to those with Lisfranc screw fixation,with the advantages of faster early postoperative recovery and reduced possibility of secondary surgery for internal fixation removal.

关 键 词：Lisfranc损伤 螺钉固定 弹性固定 

分 类 号：R683.42[医药卫生—骨科学]