切开复位内固定治疗新鲜Lisfranc关节损伤疗效观察  

Clinical efficacy of open reduction and internal fixation in treating fresh Lisfranc joint injury

作　　者：边冲[1] 陈广南 徐俊[1] 黄中岳 张懿鸣 周开锋 殷潇凡 谷辉杰[1] BIAN Chong;CHEN Guang-nan;XU Jun;HUANG Zhong-yue;ZHANG Yi-ming;ZHOU Kai-feng;YIN Xiao-fan;GU Hui-jie(Department of Orthopedics,Minhang Hospital of Fudan University,Shanghai 201199,CHINA)

机构地区：[1]复旦大学附属闵行医院骨科,上海201199

出　　处：《海南医学》2024年第19期2773-2777,共5页Hainan Medical Journal

基　　金：上海市自然科学基金(编号:22ZR1454900)。

摘　　要：目的观察新鲜Lisfranc关节损伤治疗中引入切开复位内固定方案的治疗效果。方法回顾性分析2018年4月至2022年8月复旦大学附属闵行医院骨科收治的56例新鲜lisfranc关节损伤患者的临床资料。所有患者均通过足背侧的纵向切口进行手术,复位后应用钢板、螺钉固定内侧柱和中间柱,克氏针固定外侧柱。术后随访8个月,记录随访结果,比较手术前及末次随访足功能恢复情况[美国足踝外科协会(AOFAS)踝与后足功能评分、疼痛视觉模拟评分(VAS)],并记录并发症发生情况。结果45例患者得到有效随访,骨折愈合时间10~14周,平均12.6周;术后77.78%的患者(35/45)切口愈合良好,有3例因第一跖骨基底部粉碎性骨折行跖跗关节融合术;术后6个月影像学评估结果显示39例获得解剖复位,解剖复位率为86.7%。术后末次随访AOFAS踝与后足功能评分为(84.05±6.17)分,明显高于术前的(37.12±9.33)分,而VAS评分为(1.70±0.51)分,明显低于术前的(6.81±2.20)分,差异均有统计学意义(P<0.05);随访期间3例发生内固定断裂,4例患者出现足背皮肤激惹症状,并发症发生率为15.56%(7/45)。结论切开复位内固能够明确关节损伤的范围,解剖复位骨折脱位及可靠固定,是治疗新鲜Lisfranc关节损伤的有效方法。Objective To observe the clinical efficacy of open reduction and internal fixation in the treatment of fresh Lisfranc joint injury.Methods The clinical data of 56 patients with fresh Lisfranc joint injury in Department of Orthopedics,Minhang Hospital of Fudan University were retrospectively analyzed from April 2018 to August 2022.All patients received surgery through a longitudinal incision on the dorsal side of the foot.After reduction,the medial column and the middle column were fixed with steel plates and screws,and the lateral column was fixed with Kirschner wires.The patients were followed up for 8 months after surgery,and the follow-up results were recorded.The recovery conditions of foot function(American Orthopedic Foot and Ankle Society[AOFAS]ankle and hindfoot function score,Visual Analogue Scale[VAS])were compared before surgery and at the last follow-up,and the complications were recorded.Results Forty-five patients were followed up effectively.The fracture healing time was 10-14 weeks,with an average of 12.6 weeks.After surgery,77.78%(35/45)of the patients had good wound healing,and 3 patients underwent tarsometatarsal arthrodesis due to comminuted fracture of the first metatarsal base.Imaging evaluation at 6 months after surgery showed that 39 cases obtained anatomical reduction,with an anatomical reduction rate of 86.7%.The AOFAS ankle and hindfoot function score was(84.05±6.17)points at the last follow-up after surgery,significantly higher than(37.12±9.33)points before surgery,while the VAS score was(1.70±0.51)points,significantly lower than(6.81±2.20)points before surgery,with statistically significant differences(P<0.05).During the follow-up,there were 3 cases of internal fixation fracture and 4 cases of irritation symptoms on the dorsum of the foot,and the incidence of complications was 15.56%(7/45).Conclusion Open reduction and internal fixation can clarify the scope of joint injury and results in anatomical reduction of fracture dislocation and reliable fixation,which is an effective meth

关 键 词：新鲜Lisfranc关节损伤 切开复位内固定 足部功能 AOFAS评分 疗效 

分 类 号：R684[医药卫生—骨科学]