摘要
目的分析万向锁定钢板治疗急性Lisfranc骨折脱位的疗效。方法回顾性研究自2016年12月至2017年6月四川大学华西医院骨科采用切开复位联合万向锁定钢板固定的11例(13足)Lisfranc骨折脱位患者资料,男8例(10足),女3例(3足);年龄19~57岁,平均36.4岁;11例患者中合并跖骨骨折10例,楔骨骨折伴(或)脱位6例,骰骨骨折4例,舟骨骨折1例;采用Myerson提出的分类系统对Lisfranc骨折脱位进行分类:A型1例1足,B1型2例2足,B2型5例6足,C1型2例3足,C2型1例1足。术后通过疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)中足评分评价功能。结果所有患者术后随访18~24个月,平均22个月。VAS评分从术前(7.3±1.2)分(6~9分)降低至术后(1.2±0.2)分(0~2分),AOFAS评分从术前的0分上升至术后(84.6±4.6)分,差异均有统计学意义(P<0.05)。所有患者均获解剖复位,所有骨折均一期愈合,未发生延迟愈合或不愈合。有2例患者切口边缘皮肤发生坏死,但没有发生严重感染;2例术后皮肤感觉消失,4例术后皮肤感觉减退,提示腓浅神经分支损伤。结论万向锁定钢板治疗急性Lisfranc损伤固定牢固,骨折可以解剖复位,短期临床疗效满意。
Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury. Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients (13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics, West China Hospital.They were 8 men (10 feet) and 3 women (3 feet), aged from 19 to 57 years (average, 36.4 years).Of them, 10 were complicated with fracture of metatarsus, 6 with cuneiform fracture and/or dislocation, 4 with cuboid fracture, and one with cuboid fracture.According to the Myerson classification for Lisfranc frac-ture-dislocations, one case (one foot) belonged to type A, 2 (2 feet) to type B1, 5 (6 feet) to type B2, 2 (3 feet) to type C1 and one (one foot) to type C2.The outcomes were evaluated using the visual analogue scale (VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society (AOFAS). Results This cohort was followed up for 18 to 24 months (average, 22 months).Their VAS scores were decreased signif-icantly from preoperative 7.3±1.2 (from 6 to 9) to postoperative 1.2±0.2 (from 0 to 2)(P<0.05);their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6 (P< 0.05).Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep in-fection;skin anesthesia occurred in 2 and skin hypesthesia in 4, indicating a lesion of the superficial peroneal nerve. Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability, precise reduction and satisfactory short-term clinical outcomes.
作者
陈宇
张晖
刘熹
李亚星
邓伟
任毅
吴仕舟
Chen Yu;Zhang Hui;Liu Xi;Li Yaxing;Deng Wei;Ren Yi;Wu Shizhou(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第4期314-320,共7页
Chinese Journal of Orthopaedic Trauma
