隐匿性Lisfranc损伤14例临床诊治分析

Clinical analysis of 14cases of the occult lisfranc injuries

目的：探讨隐匿性Lisfranc损伤临床早期诊断、治疗方法，避免漏诊误治。方法：回顾性分析2004—2013年诊治的低能量隐匿性Lisfranc损伤临床资料。结果：手术患者切口均I期愈合，无其他早期相关并发症发生。术后12例获随访。采用美国矫形足踝协会（AOFAS）的中足评分标准评价疗效，本组评分为75～96分，平均87．4分；获优8例，良3例，一般1例，优良率为91．7％。随访期间均未出现跖跗关节再脱位。结论：隐匿性Lisfranc损伤由于发病率低、局部解剖结构复杂、伤情隐匿、体征不明显、X线特征细微等原因导致高漏诊率、高致残率，但是只要临床医师掌握了该病的临床特征，在诊治足踝部损伤时提高警惕，通过早期诊断、解剖复位、可靠固定，都能取得较好的临床效果。

Objective：To investigate the way of early diagnosis and treatment of occult Lisfrance injury and to avoid misdiagnosis and mistreatment： Method：Clinical data of low-energy injured occult Lisfrance cases from 2004 to 2013 was retrospectively analyzed. Result：Incision were healed by first intension in all patients, and there was no early complications. 12 cases were followed up completely postoperation. The criteria of AOFAS（American Orthopedic Foot and Ankle Society）were adopted to evaluate the efficacy of operation. The scores of this group varied from 75 to 96 points,and the average was 87.4 points. According to the criteria of AOFAS,the results were excellent in 8 cases,good in 3cases,and fair in one case with an excellent and good rate of 91.7%. There was no Lisfranc dislocation occurred during the follow-up. Conclusion： There exited high rate of missed diagnosis and disability in the cases of occult Lisfrance damage due to the low incidence, complex anatomic structure,injury occult, obvious signs,and subtle features of X-ray film. If clinicians master the clinical features of occult Lisfrance,and be alert in the course of diagnosis and treatment of foot and ankle injuries, better clinical results could be achieved through early diagnosis, anatomical reduction, and reliable fixation.