一体化钢板系统结合克氏针内固定治疗Lisfranc损伤

Integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury

目的:探讨一体化钢板系统结合克氏针内固定治疗Lisfranc损伤临床疗效。方法:回顾性分析2010年1月至2018年12月收治30例Lisfranc损伤患者资料,男22例,女8例;年龄22~58岁,平均44.5岁;均为闭合性损伤,其中8例合并跖跗基底部骨折,2例合并骰骨压缩性骨折。Lisfranc关节损伤分型:单纯内侧柱损伤6例,内侧柱与中间柱损伤10例,中间柱与外侧柱损伤4例,三柱损伤10例。致伤原因:交通伤12例,机器伤10例,坠落伤8例。所有患者待软组织条件改善后,择期手术采用切开复位一体化钢板系统结合克氏针内固定,受伤至手术时间为2~7 d,平均5 d。术后评价骨折复位及愈合情况,测量跖跗关节间隙,采用美国足踝外科协会(American Association of Foot and Ankle Surgery,AOFAS)中足评分评价治疗效果。结果:术后6周,克氏针均取出。30例患者术后均获得随访,随访时间12~30个月,平均24个月,随访期间均未见伤口感染、皮肤坏死等软组织并发症。跖跗关节脱位及合并跖骨骨折和骰骨骨折均达到解剖复位,无一例出现复位丢失。合并骨折的Lisfranc损伤者,术后10~16周(平均12周)X线片示骨折骨性愈合。在重力应力位X线片上测量跖跗关节间隙,术前为(3.30±0.58)mm,术后为(0.68±0.36)mm,较术前减少2.62 mm,差异有统计学意义(t=32.542,P<0.001);术后12个月患侧为(0.70±0.23)mm,与健侧(0.65±0.26)mm比较,差异无统计学意义(P>0.05)。末次随访时AOFAS中足评分为65~95分,平均85分;其中优15例,良10例,可3例,差2例,优良率为83.3%(25/30)。术后8个月,1例患者因出现低毒反应、皮肤发红而取出一体化钢板系统后皮肤顺利愈合;术后1年,10例患者要求取出内固定;所有患者均未出现钢板、螺钉及克氏针断裂;2例三柱损伤患者分别于术后12、18个月发生创伤性关节炎,行走疼痛,遂予行跖跗关节融合术,术后疼痛消失。结论:一体化钢板系统结合克氏针内固定治疗Lisfranc损伤技术简单,可避免关节再脱位及关节面软骨再损伤,是治疗Lisfranc损伤安全、有效的方法。

Objective To investigate the clinical efficacy of integrated steel plate system combined with Kirschner wire internal fixation in the treatment of Lisfranc injury.Methods Data of 30 cases with Lisfranc injury who were admitted from January 2010 to December 2018,including 22 males and 8 females were retrospectively analyzed.The age ranged from 22 to 58 years,with an average age of 44.5 years.All of them were closed injuries,including 8 cases involving metatarsal tarsal base fracture,and 2 cases with compression fracture of dice.Classification of Lisfranc joint injury:6 cases of injury of the inner column alone,10 cases of injury of the inner column and the middle column,4 cases of injury of the middle column and the outer column,10 cases of injury of the three columns.Cause of injury:traffic injury in 12 cases,machine injury in 10 cases,fall injury in 8 cases.The time from injury to operation was 2-7 d,with an average of 5 d.After the improvement of soft tissue conditions,all patients were treated with open reduction and internal fixation using integrated plate system combined with Kirschner wire,followed up by regular post-operative imaging examination,and the therapeutic effect was evaluated by the American Association of Foot and Ankle Surgery(AOFAS)midfoot score.Results Thirty patients were followed up for 12-30 months(mean 24 months),during which no soft tissue complications such as wound infection and skin necrosis were observed.Average postoperative healing was observed at 12 weeks(10-16 weeks)for them who combined with fracture.At the latest follow-up,the AOFAS midfoot score was 65-95 points(mean 85 points).The midfoot function scores of the 30 patients were:excellent in 15 cases,good in 10,fair in 3,poor in 2.The excellent and good rate was 83.3%(25/30).One patient showed low toxicity and red skin 8 months after the operation.The integrated steel plate system was removed and the skin healed smoothly after the operation.One year after surgery,10 patients requested removal of the internal fixation.None of the patients had the complication of plate,screw and Kirschner wire fracture.Two patients with three-column injury developed traumatic arthritis and walking pain 12 and 18 months after surgery,respectively,and then underwent metatarsal tarsal joint fusion.The postoperative pain disappeared.Conclusion The integrated steel plate system combined with Kirschner wire internal fixation for the treatment of Lisfranc injury is simple,can avoid joint redislocation and articular cartilage reinjury,is a safe and effective method for the treatment of Lisfranc injury.