摘要
目的总结切开复位跨关节钢板内固定治疗Lisfranc损伤的临床经验。方法自2012年4月~2016年4月期间,我院共收治24例Lisfranc关节损伤的患者,男14例,女10例,平均年龄42.6岁,损伤按Myerson分型:A型5例;B型11例;C型8例。所有患者待足部软组织条件改善后,择期行切开复位跨关节钢板内固定术。术后定期放射学检查随访,采用美国矫形外科足踝协会(AOFAS)足评分进行治疗效果评价,并记录相关并发症。结果 24例患者术后平均随访22个月(6~36个月),随访期间未见伤口感染、皮肤坏死等软组织并发症,1例患者术后8个月复查时发现钢板断裂,但无不适主诉,予以取出内固定。1例患者术后13个月继发创伤性关节炎,出现明显疼痛伴行走困难,保守治疗无效,予行跖跗关节融合术。X线片示术后平均12周(10~16周)骨性愈合。根据AOFAS足评分标准进行。结果显示:好(>80分)11例,较好(60~80分)9例,差(<60分)4例。结论用切开复位跨关节钢板内固定治疗Lisfranc关节损伤,可避免贯穿跖跗关节固定,减少关节软骨继发损伤,可以取得良好的临床效果。
Objective To summarize the clinical experience of open reduction and cross-joint plate internal fixation in the treatment of lisfranc injury. Methods a total of 24 patients with lisfranc joint injury from April 2012 to April 2016 were admitted to our hospital. There were 14 males and 10 females with an average age of 42.6 years. Injury was clas- sified by Myerson classification： 5 cases of type A; 11 cases of type B; 8 cases of type C. All patients were given selec- tive surgery of open reduction and cross-joint plate internal fixation after the improvement of the condition of foot soft tissues. Postoperative radiological follow-up was carried out regularly. The evaluation of the therapeutic effect was per- formed using the foot scores of the American Orthopaedic Foot and Ankle Society（AOFAS）, and related complications were recorded. Results 24 patients were followed up for an average of 22 months （6 to 36 months） after the surgery. No wound infection, skin necrosis and other soft tissue complications were observed during follow-up period. The re-exam- ination in 1 case 8 months after the surgery found that the plate was broken, but there was no discomfort, and the bro- ken plate was taken out for internal fixation. Secondary traumatic arthritis in 1 case 13 months after the surgery was detected, accompanied with significant pain and walking difficulty. Conservative treatment is invalid, and metatarsal tarsal joint fusion was given. X-ray showed bone healing after an average of 12 weeks （10 to 16 weeks）. The foot score was calculated according to the AOFAS. The results showed： good （〉 80 points） in 11 cases, fair （60-80 points） in 9 cases, and poor （〈60 points） in 4 cases. Conclusion Open reduction and cross-joint plate internal fixation in the treat- ment of lisfranc injury can avoid the fixation of cross-metatarsal tarsal joint and reduce the secondary injury of articu- lar cartilage, which can achieve favorable clinical effect.
出处
《中国现代医生》
2017年第18期69-72,共4页
China Modern Doctor
基金
浙江省医药卫生科研基金项目(2017KY644)
