Lisfranc损伤切开复位螺钉内固定术后跖跗关节症状性骨关节炎的观察

Symptomatic tarsometatarsal osteoarthritis after open reduction and screwing of Lisfranc injuries

目的探讨经切开复位螺钉内固定治疗Lisfranc损伤的疗效及术后症状性骨关节炎的发生情况。方法回顾性分析2009年1月至2015年1月期间收治的28例Lisfranc损伤患者资料。男18例，女10例；平均年龄为36．1岁（19—54岁）；根据Quenu．Kuss分型：A型（同向脱位）5例；B型（单纯脱位）10例，其中Bl型（向内侧脱位）4例，B2型（向外侧脱位）6例；C型（分离脱位）13例，其中c1型（部分脱位）8例，c2型（全部脱位）5例。患者均在伤后2周内接受手术，行切开复位内固定，对第1—3跖跗关节行螺钉内固定，对第4—5跖跗关节行克氏针内固定。术后8～10周拔出克氏针，拔出后患肢开始负重。术后根据疼痛视觉模拟评分（VAS）和美国足踝外科协会（AOFAS）的中足评分进行评估。结果所有患者术后获26～72个月（平均29．9个月）随访。末次随访时VAS评分平均为2．8分；AOFAS中足评分结果：优1例，良22例，差5例，优良率为82．1％。影像学上中足有退行性改变的有患者20例（71．4％，20／28），其中18例（90．0％）出现症状性骨关节炎。骨折达到解剖复位的患者症状性骨关节炎的发生率（60．9％，14／23）与骨折未达到解剖复位患者（80．0％，4／5）比较差异无统计学意义（P=0．399）。结论采用切开复位螺钉内固定术治疗Lisfranc损伤可以取得良好疗效，损伤类型及复位质量与症状性关节炎的发生无明显关系。

Objective To explore the outcomes of open reduction and internal fixation （ORIF） with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal osteoarthritis （OA）. Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36.1 years （from 19 to 54 years）. According to the Quenu-Kuss classification, 5 patients had type-A injury, 10 type-B injury （4 cases of type-B1 and 6 ones of type-B2）, and 13 type-C injury （8 cases of type-C1 and 5 ones of type-C2）. The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society （AOFAS） midfoot scores and visual analog scale （VAS） at final follow-ups. Results The mean duration of follow-up was 29.9 months （from 26 to 72 months）. AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82.1%. The mean VAS score was 2.8. Radiographic evidence of OA was noted in 20 patients （71.4%, 20/28）, in 18 of whom （90. 0% ） symptomatic OA was observed. There was no significant difference （ P = 0. 399） in the incidence of symptomatic OA either between the patients with anatomic reduction （60. 9%, 14/23） and those without anatomical reduction （80.0%, 4/5） . Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or reduction quality.