伴骰骨压缩性骨折的Lisfranc损伤的切开复位内固定  

Open reduction and internal fixation of Lisfranc injury complicated with cuboid compression fractures

作　　者：吴采荣 张杰[2,3] 魏世隽 WU Cai-rong;ZHANG Jie;WEI Shi-jun(The 909^(th) Hospital(Dongnan Hospital Xiamen University),Zhangzhou,Fujian 363000,China;Hubei University of Medicine,Shiyan,Hubei 442000,China;Department of Orthopedics,General Hospital of PLA Central Theater Command,Wuhan,Hubei 430070,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院),福建漳州363000 [2]湖北医药学院,湖北十堰442000 [3]中部战区总医院骨科,湖北武汉430070

出　　处：《中国矫形外科杂志》2025年第4期345-350,共6页Orthopedic Journal of China

摘　　要：[目的]评价切开复位微型锁定钛板内固定治疗伴有骰骨压缩性骨折的Lisfranc损伤的临床疗效。[方法]回顾性分析2015年10月—2018年1月作者医院采用切开复位微型锁定钛板内固定伴有骰骨压缩性骨折的Lisfranc损伤21例患者的临床资料,其中男13例,女8例。评估临床和影像资料。[结果]所有患者均顺利手术,术中无血管神经损伤,平均随访(29.3±8.9)个月。随访过程中,1例患者因行走时中足部位疼痛明显行二次跖跗关节融合手术。与术前相比,末次随访时VAS评分[(5.3±0.6),(1.2±0.9),P<0.001]和AOFAS踝-后足评分[(50.1±3.4),(83.0±6.3),P<0.001]均显著改善。末次随访时,临床结果评定为优3例,良14例,可4例,差0例,优良率94.4%。影像方面,与术前相比,末次随访时台阶征位移距离(step-off sign,SOS)[(4.7±1.2)mm,(1.3±0.5)mm,P<0.001]、M1-M2间隙[(13.4±1.9)mm,(2.3±0.6)mm,P<0.001]、C1-C2间隙[(3.1±1.4)mm,(1.7±0.5)mm,P<0.001]和Meary角[(18.8±8.9)°,(2.8±0.9)°,P<0.001]均显著改善。至末次随访时2例患者外侧柱遗留轻度短缩畸形,11例患者有不同程度的跖跗关节炎征象。[结论]切开复位微型锁定钛板内固定治疗伴骰骨压缩性骨折的Lisfranc损伤,可有效恢复外侧柱长度,避免继发足部畸形的发生,临床效果满意。[Objective]To evaluate the clinical efficacy of open reduction and internal fixation(ORIF)with mini locked titanium plate for Lisfranc injury complicated with cuboid compression fractures.[Methods]A retrospective study was performed on 21 patients who received ORIF for Lisfranc injury complicated with cuboid compression fractures in our hospital from October 2015 to January 2018,including 13 males and 8 females.The clinical and imaging data were evaluated.[Results]All patients had ORIF conducted successfully without vascular and nerve injury,and followed up for a mean of(29.3±8.9)months.During the follow-up,1 patient of them underwent revision tarsometatarsal fusion due to significant pain in the middle foot during walking.Compared with those preoperatively,the VAS scores[(5.3±0.6),(1.2±0.9),P<0.001]and AOFAS ankle-hindfoot score[(50.1±3.4),(83.0±6.3),P<0.001]were significantly improved at th last followup.The clinical outcome were marked as excellent in 3 cases,good in 14 cases,fair in 4 cases poor in 0 case by the time of latest followup,with excellent and good rate of 94.4%.As for imaging,the step-off sign(SOS)[(4.7±1.2)mm,(1.3±0.5)mm,P<0.001],M1-M2 distance[(13.4±1.9)mm,(2.3±0.6)mm,P<0.001],C1-C2 distance[(3.1±1.4)mm,(1.7±0.5)mm,P<0.001],and Meary's angle[(18.8±8.9)°,(2.8±0.9)°,P<0.001]were significantly improved at the last follow-up compared with those preoperatively.Up to the last follow-up,2 patients had mild lateral column shortening deformity and 11 patients had signs of metatarsal arthritis in varying extent.[Conclusion]ORIF with mini locking titanium plate for Lisfranc injury complicated with cuboid bone compression fractures do effectively restore the length of the lateral column and avoid the occurrence of secondary foot deformities,and achieve satisfactory clinical consequence.

关 键 词：LISFRANC损伤 跖跗关节脱位 骰骨骨折 切开复位内固定 

分 类 号：R683.42[医药卫生—骨科学]