Lisfranc损伤的临床疗效分析及治疗策略探讨

Different treatment methods and clinical effects of Lisfranc fracture-dislocations

目的通过观察不同方法治疗Lisfranc损伤的临床疗效,探讨Lisfranc损伤的治疗策略。方法回顾性研究6年间11例Lisfranc损伤患者闭合复位外固定治疗(1例)、切开复位螺钉内固定治疗(9例)和切开复位克氏针内固定治疗(1例)的结果。平均随访3年,按照AO-FAS中足评分标准进行评定。结果螺钉内固定疗效优良,保守治疗和单纯克氏针内固定疗效差。结论特殊的解剖关系及生物力学特点决定了除移位轻微的单关节半脱位患者可保守治疗外,绝大多数Lisfranc损伤均应提倡早期手术治疗,解剖复位和稳定的固定是获得最佳疗效的关键。

Objective To explore different treatment methods and clinical effects of Lisfranc fracture-dislocations.Methods A total of 11 patients with Lisfranc fracture-dislocations had received closed reduction（1 case） or open reduction and internal fixation（9 cases with screws;1 case with Kirschner wires）treatment in recent 6 years.The patients were then followed up for averaged 3 year.and assessed with classified basis of AO-FAS mesopodium scores.Results The clinical effects of open reduction and internal fixation were better than closed reduction;the clinical effects of internal fixation with screw were better than with Kirschner wire.Conclusions The special characteristics of anatomic form and biomechanics advocate that most of the Lisfranc fracture-dislocations should be treated by open reduction and internal fixation in prophase,and the anatomic reduction and a stable internal fixation are the keys to obtaining the optimal therapeutic effects,except for some cases of subluxation of simple joint with insignificant displacement.