Lisfranc关节损伤手术治疗的疗效评估

Evaluation of the surgical treatment of Lisfranc injuries

目的:探讨手术治疗Lisfranc关节损伤的临床疗效。方法:自2003年1月至2009年9月,手术治疗Lis-franc关节损伤57例,男41例,女16例;年龄20～64岁,平均33.8岁。按照Myerson分类:中柱损伤31例,中柱合并内侧柱损伤15例,三柱损伤11例。受伤当日手术25例,受伤后3～11d(平均7d)手术32例。结果:切口均一期愈合,平均手术时间50min;所有患者获随访,时间4～70个月,平均35个月。患者平均AOFAS评分为(84.73±14.26)分,患者术后5.1个月(3～12个月)恢复正常生活。52例解剖复位患者平均AOFAS评分(87.63±13.71),5例未解剖复位者平均AOFAS评分(74.31±21.96)。多柱损伤患者26例平均AOFAS评分(76.58±11.51)。有8例患者并发创伤性骨关节炎,是患者中最主要的并发症。结论:手术治疗Lisfranc关节损伤能够重建跖跗关节复合体的稳定性,可取得满意的复位和临床疗效。术中复位质量与治疗结果密切相关。

Objective：To study the clinical results of surgical treatment for Lisfranc fracture-dislocation. Methods：From January 2003 to Septemper 2009,57 patients with Lisfranc injuries were treated by surgical operation included 41 males and 16 females with an average age of 33.8 years old ranging from 20 to 64 years. According to Myerson＇s classification,there were 31 cases of middle column injuries,15 cases of medial-middle column injuries and 11 cases of three-column injuries. Among them,25 patients accepted the emergency operation （24 hours） and 32 patients were treated in average 7 days （3 to 11 days） after injury. Results：All the wounds were healed primarily with a mean operative time of 50 min（30 to 70 min）. All patients were followed up for 4 to 70 months（averaged 35 months）. The total AOFAS scores（American Orthopaedic Foot and Ankle Society） was in averaged of（84.73±14.26）. All the patients returned to normal daily life after a mean time of 5.1 months （3 to 12 months）. The average AOFAS scores of 52 anatomical reduction cases was（87.63±13.71）,5 non-anatomical reduction cases was（74.31±21.96）,26 multiple column trauma cases was （76.58±11.51）. Complications of osteoarthritis occurred in 8 cases,confirming it was the main complication of these injuries. Conclusion：Lisfranc injuries can be surgically treated well. Reduction of the middle column is the key to reestablishment the stability of the tarsometatarsal joint complex. The quality of the reduction correlated with treatment outcome.