分期治疗伴有严重软组织损伤的Lisfranc骨折脱位

Staged treatment for Lisfranc fracture-dislocation with severe soft tissue injury

目的探讨分期治疗伴有严重软组织损伤的Lisfranc骨折脱位中短期疗效。方法 2009年9月至2014年3月,采用一期清创缝合,二期微型钢板、空心钉及克氏针内固定治疗伴有严重软组织损伤的Lisfranc骨折脱位患者18例,年龄22-65岁,平均（38.32±4.33）岁。根据美国足踝骨科学会（AOFAS）中足评分和疼痛视觉模拟评分（VAS）评价疗效。结果所有患者中有16例获得有效随访,平均随访（13.38±4.45）个月（6-25个月）。二期手术时间距受伤时间为（17.62±2.61）d（12-22 d）,手术时间为（82.98±14.03）min（68-110 min）。所有患者骨折均一期愈合,无再次骨折及脱位发生。末次随访时AOFAS中足评分为（78.36±5.8）分（66-90分）,其中优1例,良12例,可3例,优良率为81.2%,VAS评分为（2.76±0.45）分（0-6分）。结论对于伴有严重软组织损伤的Lisfranc骨折脱位患者,采取一期消肿、清创缝合,二期钢板、空心钉及克氏针内固定治疗,疗效良好。

Objective To analyse the mid-term outcome of staged treatment for Lisfranc fracture-dislocation with severe soft tissue injury.Methods From September 2009 to March 2014,18 patients who were 22 to 65 years old（mean,38.32±4.33 years old）of Lisfranc fracture-dislocation with severe soft tissue injury were treated by staged procedure,composed of debridement in the first stage,final open reduction and internal fixation in the second stage.The clinical results were evaluated with American Orthopaedic Foot and Ankle Society（AOFAS）mid-foot score and visual analogue scale（VAS）.Results Sixteen patients were followed up for 6-25 months（mean,13.38±4.45 months）.There were 12-22 days（mean,17.62±2.61 days）from injury to final operation.All cases were healed without nonunion and loss of reduction.At final follow-up,the AOFAS mid-foot score was 66-90（mean,78.36±5.8）,there was excellent in 1 case,good in 12 cases,fair in 3 cases,with the excellent and good rate of 81.2%.The VAS score was 0-6（mean,2.76±0.45）.Conclusion For Lisfranc fracture-dislocation with severe soft tissue injury,the staged treatment can yield good clinical results with less soft tissue complications.