闭合复位经皮空心螺钉内固定治疗隐匿型Lisfranc损伤的效果研究

Closed reduction percutaneous cannulatedscrew fixation for treatment of subtle Lisfranc injury

目的探讨闭合复位经皮空心螺钉内固定治疗隐匿型Lisfranc损伤的临床效果。方法北京市顺义区医院于2017年1月至2022年1月收治隐匿型Lisfranc损伤患者35例,男22例、女13例,所有患者均采用C型臂透视下闭合复位、复位钳加压。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)中足评分、患者简明健康量表(the MOS item short from health survey,SF-36)评分和视觉模拟评分法(visual analogue scale,VAS)评分评估临床效果,随访观察临床结果和并发症发生情况。结果术后所有患者的切口均一期愈合,无感染和皮肤坏死等切口并发症,无血管和神经损伤。随访时间3~36个月,平均(22.5±4.8)个月;骨折愈合时间8~12周,平均(6.5±0.3)周。末次随访AOFAS中足评分为(80.1±6.1)分,VAS评分为(2.2±0.3)分,SF-36的生理评分为(81.4±6.7)分,SF-36的躯体疼痛评分为(84.5±7.6)分。末次随访时,3例出现空心螺钉松动,均无症状,未出现断钉现象;2例出现轻度关节退变,无症状,未做处理。足部功能根据AOFAS评分标准评定:优22例,良7例,可6例,优良率为82.86%。结论闭合复位经皮空心螺钉内固定治疗隐匿型Lisfranc损伤的效果显著。

Objective To investigate the clinical effect of closed reduction and percutaneous cannulate dscrew fixation in the treatment of subtle Lisfranc Injury.Methods 35 cases of subtle Lisfranc injury were included from January 2017 to January 2022 in Shunyi District Hospital,including 22 males and 13 female.All patients were treated with closed reduction under C-arm fluoroscopy and reduction clamp compression.the American Orthopaedic Foot and Ankle Society(AOFAS)midfoot score and the MOS item short from health survey were used.The clinical efficacy was evaluated by SF-36 score and visual analogue scale(VAS)score.The clinical results and complications were followed up.Results All the incisions healed in the first stage after surgery.There were no complications such as infection and skin necrosis,and no vascular and nerve injury.The average follow-up time was(22.5±1.8)months from 3 month to 36 months.The fracture healing time was 8~12 weeks with a mean of(6.5±0.3)weeks.At the last follow-up,the median AOFAS score was(80.1±6.1)points,VAS score was(2.2±0.4)points,SF-36 physiological score was(81.4±6.7)points,and SF-36 somatic pain score was(84.5±7.6)points.At the last follow-up,3 cases of cannulated screw loosening without symptom and no screw breakage occurred;And 2 cases of mild joint degeneration were asymptomatic and untreated.According to the AOFAS,22 patients were excellent,7 were good,and 6 were fair,with an excellent and good rate of 82.86%.Conclusion Closed reduction and percutaneous cannulated screw fixation in the treatment of subtle Lisfranc Injury is satisfactory and worthy of clinical application.