桥接固定治疗跖跗关节损伤

Bridging fixation for Lisfranc injury

目的探讨使用桥接钢板或外固定支架吲定治疗跖跗关制员伤的临床疗效、方法埘2008年8月至2011年2月收治的26例跖跗关节损伤患者的病例资料进行回顾性研究，W19例，女7例；年龄19～56岁，平均34岁。损伤按Myerson三柱损伤分型：单柱损伤2例，两柱损伤8例，二性损伤16例。采川桥接钢板同定10例，外嗣定支架固定16例。术后定期放射学检奄随访，采川荚㈨足踝外科协会（A（WAS）中足评分进仃功能评价。比较术后6个月和18个月AOFAS评分。结果所有患行术后挟18～49个，（平均27个月）随访、伤口均愈合良好，术见感染征象，未发现钢板、螺钉松动、脱Ⅲ、断裂硬蚌物眨应等与内代物相关的并发症、12例患者继发创伤性关节炎，2例因疼痛明显、行走受限二期行关节融合术。所有患者术后6个月和18个月的平均AOFAS中足评分分别为（59．6±15．4）分和（76．8±11．5）分，差异有统计学意义（t=12．620，P=0．000）。结论埘于低能量跖跗关节损伤忠扦他川桥接钢板．避免贯穿跖跗火节㈨定，町以减少父节软骨继发损伤。对于离能最跖跗火节损伤患者应重视柱的粉碎骨折造成的短缩问题，使用桥接外同定支架，恢复柱长度的解剖复痊和可靠固定是获得良好疗效的关键。

Objective To report the outcomes of Lisfrane injury treated with bridging plating or exlerllal fixalion. Methods From August 2008 to February 2011, 26 eases of Lisflanc injury were treated with bridging plating ur external fixalion in our department. After diagnosis was confirmed by X-ray exarnination or/and CT scanning, open reduction and internal fixation was peribrmed with a bridging plate or external fixator. Regular X-ray fbllow-ups were carried out to evaluate f＇unetiorml recovery by the American thupedic Foot and Ankle Society （AOFAS） midfiot score. The AOFAS scores 6 munfls and 18 months after operation were compared. Results This series got an average lollow-up of 27 mnnlhs, ranging tom 18 to 49 months. The AOFAS midloot score 6 months after operation was 59.6 ± 15.4 points, signifieantly lower than that 18 months after operation （76. 8 ± 1 I. 5 points） （ t = 12. 620, P = 0. 000）. Seeondaty post-tratunatlv arthritis occurred in 12 eases, 2 of which had secondary arthrudesis as a resuh of severe pain. There was 1. internal fixation breakage. Conclusions For cases of low energ7 lAsfranc injury, bridging p]ating can redtn＇e secondaL, injury to the articular cartilage,. For cases of high energy Lisfranc injury, bridging external fixation can lead toreliable fixation and anatomical redueliun to restnre the shortened eohmm height.