摘要
目的：分析陈旧性Lisfranc损伤患者分期治疗的短期疗效。方法15例陈旧性Lisfranc损伤患者(16足)采用阶段性治疗,损伤后治疗的平均时间为4.8个月(3~8个月)。第一阶段采用外支架以1~2 mm/d的速度撑开Lisfranc关节,第二阶段行切开复位内固定,一般能够复位所有的骨折脱位,并行关节外钢板螺钉内固定。采用Fisher精确检验法比较分类变量以及配对t检验或Wilcoxon符号秩检验比较连续变量。结果15例患者均获门诊随访,随访的平均期限为2.2年(1.0~3.0年),其疼痛视觉模拟评分量表评分平均为3.1分,美国足踝外科协会踝与后足评分标准评分平均为55.8分(43~98分),与术前相比显著升高(P=0.001)。两阶段手术治疗的平均间隔为3.2周(2.5~4.5周),15例患者全部获得解剖复位。在最终的随访中,有2例患者出现复位丢失。有5例患者发生术后创伤性关节炎,由于持续性疼痛最终都行了关节融合术。结论对于陈旧性Lisfranc损伤,分期复位和关节外固定可以获得良好的复位,坚强的稳定,降低术中骨折风险,近期疗效良好,但远期疗效有待进一步随访。
Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4. 8month ( 3 to 8 month) . In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF ( open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’ s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years ( mean 2. 2 years) in the clinic. The visual analogue scale score averaged 3. 1 points at the final follow-up, the average AOFAS scores for these patients were 55. 8 points ( range, 43 to 98 points), with a significant increase than before surgery ( P=0. 001). The mean duration between two surgeries was 3. 2 weeks (range 2. 5-4. 5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture. The short-term effectiveness is good, but the long-term effectiveness needs further follow-up.
出处
《国际外科学杂志》
2016年第11期-,共5页
International Journal of Surgery
基金
国家自然科学基金项目(81071506)@@@@National Natural Science Foundation of China
