一期内固定治疗C型Lisfranc骨折脱位疗效分析

Efficacy of one-stage internal fixation for treatment of type-C Lisfranc fracture dislocation

目的研究分析微型钢板结合空心钉辅助克氏针一期内固定治疗24例MyersonC型lisfranc骨折脱位患者的中短期疗效。方法2006年6月至2011年9月，采用微型钢板结合空心钉辅助克氏针一期内固定治疗24例MyersonC型Lisfranc骨折脱位患者（20-50岁，平均29．24±5．32岁），其中（C1型16例，C2型8例。根据美国足踝骨科协会（AOFAS）踝后足评分和疼痛视觉模拟评分（VAS）评价治疗效果。结果术后24例均获10-49个月（平均11．32±7．32个月）随访。手术时间平均80．3±11．2min。X线片检查显示24足均获解剖复位，足弓形态恢复正常。所有骨折皆一期愈合，无再次骨折脱位情况发生。术后2例出现浅表感染，2例出现皮缘坏死，2例出现足拇趾外翻畸形，5例出现负重及行走痛（2例较轻，3例口服消炎止痛药物可明显缓解，均不影响生活）。末次随访时AOFAS评分为68-98分，平均81．35±3．24分；C1、C2型评分差异无统计学意义（P=0．751）。VAS评分为0～6分，平均3．6±0．5分。结果优13例，良8例，一般2例，差1例，优良率为87．5％。结论采用微型钢板结合空心钉辅助克氏针内固定治疗C型Lisfranc骨折脱位，可达到一期解剖复位固定效果。尽管仍存在一些并发症，但对症处理效果满意，整体疗效良好。

Objective To study the clinical results of one-stage open reduction and internal fixation with mini plates plus cannulated screws assisted by K wires for treatment of type-C Lisfranc fracture dislocation. Methods From June 2006 to September 2011, 24 patients of 20 to 50 years old （mean, 29.24 ± 5.32 years old） with Lisfranc fracture dislocation were treated by open reduction and internal fixation with minplates plus cannulated screws assisted by K wires. According to Myerson classification, there were 16 cases of type C18 cases of type C2. American Orthopaedic Foot and Ankle Society （AOFAS） ankle hindfoot scale and visual analogue scale （VAS） were used for the outcome measurement at the final following up. Results All patients were followed up for 10 49 months （mean, 11.32 ± 7.32 months）. The mean operation time was 80. 3 ±11.2 minutes. Xrays showed anatomical reduction, the foot arch formed back to normal. All fractures were to get a bon healing, without new fractures and dislocations. There were two cases developed superficial infection, two with skin edge necrosis, two with hallux valgus deformity change and five had weight bearing or walking pain. At the last follow up, AOFAS score was 68-98 points （mean, 81.35 ± 3.24 points）, there was no significant difference between two types （P= 0. 751）. The VAS score was 0-6 points （mean, 3.6± 0.5 points）. There were excellent results in 13 cases, good in 8 cases, fair in 2 cases, poor in 1 case, with an excellent and good rate of 87.5 %. Conclusions We can offer an anatomic reduction and internal fixation for the type-C Lisfranc fracture dislocation with mini plates plus cannulated screws assisted by K wires. Although still has some complications, treated with satisfactory effect, the overall effect is good.