切开复位内固定治疗新鲜与陈旧隐性Lisfranc损伤的比较研究

Effectiveness of open reduction and internal fixation for acute and delayed occult Lisfranc injuries

目的比较切开复位内固定(open reduction and internal fixation,ORIF)治疗新鲜与陈旧隐性Lisfranc损伤的疗效。方法回顾分析2010年7月-2015年7月采用ORIF治疗且符合选择标准的隐性Lisfranc损伤患者临床资料,其中14例于伤后6周内手术(新鲜组),12例于6周后手术(陈旧组)。两组患者性别、年龄、损伤侧别以及术前疼痛视觉模拟评分(VAS)、美国矫形足踝协会(AOFAS)评分、简明生活质量量表(SF-12量表)心理及生理评分比较,差异均无统计学意义(P>0.05)。术后摄X线片,观察Lisfranc关节复位、内固定物在位情况以及有无创伤后关节炎等并发症发生。采用VAS评分评价关节疼痛程度,AOFAS评分评价中足功能,SF-12量表心理及生理评分评价患者生活质量。结果术后两组切口均Ⅰ期愈合,无相关并发症发生。两组患者均获随访,其中新鲜组随访时间12~24个月,平均15个月;陈旧组随访时间12~23个月,平均15个月。末次随访时,两组VAS评分、AOFAS评分、SF-12量表生理及心理评分均优于术前(P<0.05);组间比较差异均无统计学意义(P>0.05)。新鲜组患者手术疗效满意率100%,陈旧组为83.3%(10/12)。术后9~24个月20例患者(新鲜组11例、陈旧组9例)二次手术取出内固定物,平均取出时间为14.5个月。X线片复查示随访期间未见关节炎表现及中足塌陷,无内固定失效及复位丢失。结论 ORIF治疗新鲜和陈旧隐性Lisfranc损伤可获得相似疗效。

Objective To evaluate the effectiveness of open reduction and internal fixation(ORIF) in treatment of acute and delayed occult Lisfranc injuries. Methods A retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury(acute group) and 12 patients were treated after 6 weeks of injury(delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale(VAS) score,American Orthopedic Foot and Ankle Society(AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey(SF-12)(P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12. Results All incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months(range, 12-24 months) in acute group and 15 months(range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups(P<0.05). And there was no significant difference in all indicators between the two groups(P>0.05). The satisfaction rates were 100% and 83.3%(10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients(11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation(mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period. Conclusion ORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.