目的比较切开复位内固定(open reduction and internal fixation,ORIF)治疗新鲜与陈旧隐性Lisfranc损伤的疗效。方法回顾分析2010年7月-2015年7月采用ORIF治疗且符合选择标准的隐性Lisfranc损伤患者临床资料,其中14例于伤后6周内手术(...目的比较切开复位内固定(open reduction and internal fixation,ORIF)治疗新鲜与陈旧隐性Lisfranc损伤的疗效。方法回顾分析2010年7月-2015年7月采用ORIF治疗且符合选择标准的隐性Lisfranc损伤患者临床资料,其中14例于伤后6周内手术(新鲜组),12例于6周后手术(陈旧组)。两组患者性别、年龄、损伤侧别以及术前疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)评分、简明生活质量量表(SF-12量表)心理及生理评分比较,差异均无统计学意义(P>0.05)。术后摄X线片,观察Lisfranc关节复位、内固定物在位情况以及有无创伤后关节炎等并发症发生。采用VAS评分评价关节疼痛程度,AOFAS评分评价中足功能,SF-12量表心理及生理评分评价患者生活质量。结果术后两组切口均Ⅰ期愈合,无相关并发症发生。两组患者均获随访,其中新鲜组随访时间12~24个月,平均15个月;陈旧组随访时间12~23个月,平均15个月。末次随访时,两组VAS评分、AOFAS评分、SF-12量表生理及心理评分均优于术前(P<0.05);组间比较差异均无统计学意义(P>0.05)。新鲜组患者手术疗效满意率100%,陈旧组为83.3%(10/12)。术后9~24个月20例患者(新鲜组11例、陈旧组9例)二次手术取出内固定物,平均取出时间为14.5个月。X线片复查示随访期间未见关节炎表现及中足塌陷,无内固定失效及复位丢失。结论 ORIF治疗新鲜和陈旧隐性Lisfranc损伤可获得相似疗效。展开更多
AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify ...AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good 展开更多
文摘AIM To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union.METHODS Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years(19-57 years) and a mean follow-up of 6 years(2-10 years). All patients presented an atrophic nonunion with a mean length of the bone defect of 1.8 cm(1.2-4 cm). Complications and clinical results after surgical treatment were recorded. RESULTS Mean time to resolution of the infectious process was 8.2 wk(range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo(range 2-10 mo) after the second step surgery. Cultures on intraoperative samples werepositive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5(27.8%) patients, satisfactory in 10(55.5%) and unsatisfactory in 3(16.7%) patients. No activities of daily living(ADLs) limitations were reported by 12(66.6%) patients, slight by 3(16.6%) and severe limitation by 3(16.6%) patients. Mean visual analog scale at the last follow-up was 1(0-3).CONCLUSION The two-step technique has proven to be effective to achieve resolution of the infectious process and union with good
