Endobutton钢板重建Lisfranc韧带的早期疗效观察

Short-term effectiveness of Endobutton plate in reconstruction of Lisfranc ligament

目的总结跖跗关节损伤中采用Endobutton钢板重建Lisfranc韧带的早期临床疗效。方法2015年3月—2018年7月,采用Endobutton钢板重建Lisfranc韧带治疗18例跖跗关节损伤患者。男12例,女6例;年龄16~55岁,平均32.5岁。致伤原因:交通事故伤8例,高处坠落伤3例,压砸伤4例,扭伤3例。Myerson分型:A型10例,B1型4例,B2型2例,C1型1例,C2型1例。受伤至手术时间3~9 d,平均4.9 d。术后定期行X线片复查,测量第1、2跖骨关节间隙距离;采用疼痛视觉模拟评分(VAS)评价疼痛缓解情况。末次随访时,测量并比较健、患侧足弓高度以评估跖跗关节复位情况,根据美国矫形足踝协会(AOFAS)评分评价足部功能。结果患者均获随访,随访时间10~28个月,平均15.8个月。术后切口均Ⅰ期愈合。X线片复查示无螺钉松动、钢板断裂等并发症发生。术后3个月、内固定物取出前及末次随访时,第1、2跖骨关节间隙距离以及VAS评分与术前比较,差异均有统计学意义(P<0.05);术后各时间点间差异均无统计学意义(P>0.05)。末次随访时,患侧足弓高度为(5.3±0.2)mm,与健侧(5.4±0.3)mm比较,差异无统计学意义(t=1.798,P=0.810)。根据AOFAS评分评价足部功能为(89.5±7.3)分;获优12例、良4例、可2例,优良率88.9%。结论采用Endobutton钢板重建Lisfranc韧带,能较好地稳定跖跗关节,获得满意的早期足部功能。

Objective To observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury.Methods Between March 2015 and July 2018,18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate.There were 12 males and 6 females with an average age of 32.5 years(range,16-55 years).The causes of injury were traffic accident in 8 cases,falling from height in 3 cases,crushing by a heavy objective in 4 cases,and spraining in 3 cases.There were 10 cases of Myerson type A,4 of type B1,2 of type B2,1 of type C1,and 1 of type C2.The interval between injury and operation ranged from 3 to 9 days(mean,4.9 days).X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints,and the visual analogue scale(VAS)score was used to evaluate the pain relief.At last follow-up,the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches.The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS)score.Results The average follow-up time was 15.8 months(range,10-28 months).All incisions healed by first intention.X-ray reexamination showed that there was no screw loosening or plate fracture.There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation,before removal of the internal fixator,and at last follow-up when compared with preoperative values(P<0.05).There was no significant difference between the time points after operation(P>0.05).At last follow-up,there was no significant difference in the arch height between affected foot[(5.3±0.2)mm]and healthy foot[(5.4±0.3)mm](t=1.798,P=0.810).The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases,good in 4 cases,and fair in 2 cases.The excellent and good rate was 88.9%.Conclusion The reconstruction of Lisfranc ligament withEndobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.