手术治疗Lisfranc关节损伤13例的疗效分析

Curative effect analysis of surgical treatment of Lisfranc joint injuries

目的:探讨手术治疗Lisfranc关节损伤的临床疗效及影响因素。方法:自2009年1月至2011年11月,共收治Lisfranc关节损伤13例14足,男9例,女4例;年龄18～61岁,平均42岁。Myerson分型:A型1足,B型9足,C型4足。所有患者在伤后22d内接受手术,手术采用切开复位螺钉或克氏针内固定(1例开放性采用外固定架固定)。术后采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足评分标准进行功能评估;术前、术后摄X线正斜或侧位片,进行影像学评估。结果:所有患者获得随访,时间5～30个月,平均20个月。术后根据AOFAS足评分,优8足,良4足,中2足。X线片示12例获得解剖复位,所有患者骨性愈合。1例出现皮肤切缘坏死,经换药后愈合;1例开放性骨折皮肤回植后出现坏死,行皮瓣修复后愈合。其余病例未见任何手术并发症。结论:切开复位内固定是治疗Lisfrancs关节损伤的有效方法,术前软组织损伤的评估、术中骨折复位及术后复位的维持可影响临床结果。

Objective ：To investigate the clinical results and influence factors in surgical treatment of the Lisfranc joint injury. Methods： From Jan. 2009 to Nov. 2011,13 patients （ 14 feet） with Lisfrane joint injury received open reduction and screw or wire or external fixation including 9 males and 4 females with an average age of 42 years old ranging from 18 to 61 years. According to the Myerson classification,there were 1 case of type A,9 of type B and 4 of type C. All the patients received open reduction and internal （ 1 with external） fixation with screw or Kirschner wire within 22 days after injury. The post- operative function was estimated by mid-foot scoring scale of AOFAS. X-ray were used in radiography estimation. Results ： All the patients were followed up for 5 to 30 months （averaged 20 months）. According to mid-foot scoring scale of AOFAS ,there were 8 feet with excellent results,4 with good and 2 with fair results. The anatomical reduction was observed in 12 feet and all the patients obtained bony union according to the results of X-ray. Conclusion： Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury. A preoperative estimate ,proper reduction during operation and maintainence after operation may influence the clinical results.