Lisfranc损伤一期切复内固定与延期融合治疗的比较

Treatment of Lisfrane Joint Injury: Comparison of Open Reduction and Internal Fixation with Secondary Corrective Arthodesis

目的:比较Lisfranc损伤的一期切开复位内固定与二期矫形关节融合的疗效。方法:对27例Lisfranc关节损伤患者行一期切复克氏针、螺钉或钢板内固定,对23例患者行二期畸形矫正关节融合术。按照Maryland足部评分及AOFAS中足评分标准进行疗效评定。结果:AOFAS评分一期切复内固定组平均84.9,二期融合组平均71.5。Maryland评分一期切复内固定组平均87.2,二期矫形关节融合组平均72.3。一期切复内固定组术后5.1个月(3～12个月)恢复正常生活,二期矫形关节融合组术后6.3个月(4～16个月)恢复正常生活,切复内固定组6例并发骨关节炎,融合组出现1例延迟融合。结论:Lisfranc骨折脱位一期切开复位内固定治疗,功能改善更明显,患者满意度较高。二期融合也能明显缓解疼痛,改善功能。

Objective To discuss the treatment of Lisfrane joint injury by ORIF （open reduction and internal fixation） and secondary corrective arthrodesis.Methods Twenty-seven cases of Lisfrane injuries were surgically treated by ORIF and 23 cases by secondary corrective arthrodesis.The AOFAS （American Orthopaedic Foot and Ankle Society midfoot core ） and Maryland foot score were used to quantify the functional outcome.Results In the ORIF group 25 patients were available for follow-up at a mean of 36 months and in the arthrodesis group 22 patients of 30 months after operation.The mean score by AOFAS was 84.9 in the ORIF group and 71.5 in the arthrodesis group while by Maryland score 87.2 in the ORIF group and 72.3 in the arthrodesis group.The patients returned to normal daily life after a mean time of 5.1 months in the ORIF group and 6.3 months in the arthrodesis group.Complications such as osteoarthritis occurred in 6 cases in the ORIF group and delayed union in 1 case in the arthrodesis group.Conclusion Open reduction and internal fixation of Lisfrane injury lead to improved functional results.And delayed corrective arthrodesis can also release pain and lead to patient’s satisfaction.