Lisfranc损伤不同内固定治疗方式临床疗效比较研究

A clinical comparative study on the choice of internal fixation methods for treatment of Lisfranc injury

目的通过比较治疗Lisfranc骨折损伤中应用背侧桥接钢板和横向螺钉及联合应用2种固定在治疗结果方面的差异,评判哪种固定方式更优。方法共纳入2014年7月1日至2017年1月31日该科收治的62例Lisfranc损伤患者,纳入标准包括:随访6个月,每例骨折采用Hardcastle分类系统,研究对象分为四组:横向螺钉组、桥接钢板组、联合组、保守组。结果的评估包括:Kellgren-Lawrence骨性关节炎分级系统、解剖复位的Wilppula分类。结果联合保守组发生3级或4级骨性关节炎的风险明显增加,是单独使用背侧桥接钢板的3.01倍[95%置信区间(95%CI)1.036~8.470,P=0.009]。多因素分析根据解剖复位质量评估与患严重骨性关节炎风险增加有关,显示良好的解剖复位比解剖复位不良造成严重骨性关节炎的风险降低18.2倍(95%CI 15.9~21.8),与采用哪种固定方式无相关性(P>0.05)。结论在早期阶段,使用钢板或螺钉治疗Lisfranc骨折脱位在在影像学方面治疗效果相当,尽管钢板固定可能发生更多并发症,如平足症。功能结果应是检验哪种手术方式优越性的标准。最后,应制定一套更完善的Lisfranc骨折脱位的分类系统来为指导内固定的选择和可能导致的临床结果提供一个指南。

Objective By comparing the differences between the 2 types of fixation in the treatment of Lisfranc fracture damage,which is better with the application of the dorsal bridge plate and lateral screw and the combined application of the fixation in the treatment results.Methods A total of 62 patients with Lisfranc injury of the department from 2014 to January 31,2017 were included.The inclusion criteria included:follow up for 6 months,each case was divided into 4 groups:transverse screw group,bridging plate group,combined two group and group.The assessment included Kellgren-Lawrence osteoar-thritis grading system and Wilppula classification of anatomical reduction.Results The risk of osteoarthritis at grade 3 or 4 in the combined use of bridge plate and lateral screw group was significantly increased,3.01 times as much as the single use of the dorsal bridge plate(95%confidence interval 1.036-8.470,P=0.009).The multifactor analysis was related to the increased risk of severe osteoarthritis based on the anatomic reduction quality assessment and showed that the risk of severe anatomic reduction was 18.2 times lower than that of anatomic reduction(95%confidence interval 15.9-21.8),which was not associated with the type of fixation(P<0.005).Conclusion At the early stage,the treatment of Lisfranc fracture dislocation with plate or screw is quite effective in imaging,although plate fixation may have more complications,such as flat foot.The functional outcome should be the criteria for testing the superiority of which surgical procedure.Finally,a more complete set of classification systems for Lisfranc fracture dislocation should be developed to provide a guide for guiding the selection of internal fixation and the possible results of the clinical outcome.