不同方法治疗跖跗关节损伤疗效分析

Different treatments of tarsometatarsal joint injuries

目的探讨不同方法治疗跖跗关节损伤的临床疗效。方法分别采用石膏固定、闭合复位经皮内固定、开放复位内固定和二期关节融合术治疗35例跖附关节损伤患者。结果患者均获随访,时间12～36(22±1.5)周,骨折愈合时间16～28(18±2)周。术后12周33例患者能穿平常鞋子在各种地面上行走,步态基本正常。按AOFAS评分:优11例,良18例,可5例,差1例。结论解剖复位、牢靠固定是治疗跖跗关节损伤的基本原则。重建跖跗关节复合体是稳定的关键,并且需要重视对跖跗关节的整体化治疗。

Objective To investigate the clinical results of different treatments of tarsometatarsal joint injuries. Meth- ods 35 Lisfranc injuries were treated with cast immobilization, close reduction and internal fixation, open reduction and internal fixation and secondary stage arthrodesis. Results Patients were followed up for 12 - 36 （22 ± 1.5 ） weeks. Fracture healing time was 16 -28 （18 ± 2） weeks. 12 weeks after surgery, 33 patients could wear normal shoes in a variety of ground walking with normal gait. There were excellent in 11 patients, good in 18 patients, fair in 5 patients and poor in 1 patient according to the American Orthopaedic Foot and Ankle Society （AOFAS） midfoot score. Conclusions Anatomical reduction and stable fixation of Lisfranc injuries is the principle that leads to the best outcomes. Reduction of the Lisfranc ligament is the key to restablishment of the tarsometatarsal joint complex. Emphasis on the whole treatment of the Lisfranc joint should be applied.