合并跟骨前外侧骨折Lisfranc损伤的治疗

Treatment of Lisfranc injury with anterolateral calcaneal fracture

目的探讨合并跟骨前外侧骨折Lisfranc损伤的治疗方法及效果。方法自2005年9月至2016年9月,共收治10例合并跟骨前外侧骨折Lisfranc损伤患者,其中男8例,女2例,平均年龄(39.5±10.3)岁(24～55岁),均为闭合性骨折。所有患者入院后积极完善相关辅助检查,消肿对症治疗,待肿胀消褪、软组织条件改善后,择期行切开复位内固定治疗。结果所有患者术后早期均未见伤口感染、皮肤坏死等软组织并发症。共9例患者获最终随访,平均随访时间36个月(12～60个月)。影像学随访明确术后平均12周骨性愈合(10～15周)。末次随访时美国骨科足踝外科协会(AOFAS)中足评分为(83.6±6.5)分(73～94分),疼痛直观模拟量表(VAS)评分为(1.2±1.3)分(0～4分)。随访期间未见内固定失效、骨不连及畸形愈合等并发症,有1例患者随访期间影像学显示为中足创伤性关节炎,但疼痛轻微,经口服药物及支具保护等保守治疗后,病情无进展。结论合并跟骨前外侧骨折Lisfranc损伤多由高能量外展暴力所致,临床漏诊率较高。因此,临床应重视整个中足的评估,对于跟骰关节面骨折移位者,手术治疗可获得较好的治疗效果。

Objective To discuss the technique and clinical outcome of treatment for Lisfranc injury with anterolateral calcaneal fracture. Methods Ten patients of Lisfranc injury with anterolateral calcaneal fracture were enrolled from September 2005 to September 2016, including 8 males and 2 females with an average of （39.5±10.3 ） years old （24-55 years）. After detailed examination and improvement of soft tissue condition, an open reduction and internal fixation （ORIF） was performed in all cases. Results No soft tissue complications were seen in all cases. Nine patients were followed with a mean time of 36 months （12-60 months）. The X-ray manifested an average of 12 weeks （10-15 weeks） for bone union. The AOFAS midfoot score was （83.6±6.5）（73-94）, while the VAS score was （1.2±1.3） （0-4） at final follow-up. There was no complication of implant failure, non-union or malunion. The post-traumatic arthritis occurred in one case with mild pain, which was controlled with a conservative management. Conclusion Lisfranc injury with anterolateral calcaneal fracture was caused by high velocity forces with a high rate of misdiagnosis. Therefore, surgeons should attach importance to the investigation of whole midfoot. For the patients with a displaced fracture of calcanocuboid facet, an acceptable ouctome could be achieved with a surgical treatment.