陈旧性跖跗关节骨折脱位

Old Lisfranc fracture- dislocations

目的分析跖跗关节(Lisfranc)骨折脱位急诊处理的不当所导致的后期功能障碍的原因,并结合现今在这一领域的研究状况进行讨论。方法从2000年3月～2005年2月共收治陈旧性Lis-franc骨折脱位34例,24例行切开复位内固定,10例患者行关节融合术。结果按美国骨科足踝外科协会(AOFAS)中足部分的评分标准,50～60分2例,60～70分4例,70～80分5例,80～90分18例,90～100分5例。结论Lisfranc损伤晚期并发症的出现与复位不彻底、固定不牢靠以及固定时间不充分有关。临床医生在遇到中足扭伤的患者时,要提高警惕,以免漏诊。对大多数患者而言,以伤后6周内进行切开复位内固定为好。

Objective To analyze and discuss the causes of late dysfunction following the mismanagement of acute Lisfrane fracture-dislocations in light of the latest advancement in this field. Methods From March 2000 to February 2005. we treated 34 cases of old Lisfrane fraeture-dislocation. 24 cases were treated with open reduction and internal fixation. and 10 with arthrodesis. Results According to the AOFAS for midfoot. 2 cases scored 50 to 60. 4 cases scored 60 to 70. 5 cases scored 70 to 80. 18 cases scored 80 to 90 and 5 cases scored 90 to 100. Conclusions Since the incidence of Listrane fracture-dislocation tends to increase, clinic orthopedists thopedists must take great care to examine the midfoot strain lest a case should be overlooked. The late complications are related to poor reduetion, inadequate fixation, or inadequate postoperative immobilization. For most patients. open reduction and internal fixation within 6 weeks after injure is preferred. The cannulated screws are simple and stable for fixation of lateral and medial columns, and serew removal should be done 3 to 4 months after surgery to prevent recurrent diastasis and screw breakage.