基于三柱理论的选择性柱融合术治疗Lisfranc损伤畸形愈合的中期疗效分析

Selective column arthrodesis based on three-column theory for malunion of Lisfranc injury

目的分析采用基于三柱理论的选择性柱融合术治疗Lisfranc损伤畸形愈合的中期疗效。方法回顾性分析2011年1月至2020年1月于浙江大学医学院附属第二医院骨科行选择性柱融合术治疗的28例Lisfranc损伤畸形愈合患者资料。男18例,女10例;年龄平均37.2岁(18~65岁);左侧12例,右侧16例;根据Myerson三柱分型理论分型:内侧柱损伤(A型)1例,中间柱损伤(B型)4例,内侧柱合并中间柱损伤7例,三柱损伤16例。内侧柱融合7例,中间柱融合4例,内侧柱+中间柱融合17例。比较术前、末次随访时美国足踝外科协会(AOFAS)的中足评分、疼痛视觉模拟评分(VAS)评估改善情况,并记录手术相关并发症。结果所有患者均获随访,时间平均为35.6个月(18~60个月)。AOFAS的中足评分由术前(43.1±4.1)分(32~62分)升至末次随访时(84.1±7.4)分(78~94分),VAS评分由术前(5.7±1.3)分(6~9分)降至末次随访时(2.0±0.9)分(0~3分),差异均有统计学意义(P<0.001)。28例患者伤口均愈合,其中3例患者术后伤口渗出,经换药后获得延迟愈合。无患者出现腓深神经损伤、深静脉血栓形成等并发症。5例患者于融合术后1年左右取出内固定。结论基于三柱理论的选择性柱融合术治疗Lisfranc损伤畸形愈合,可获得满意的中期疗效。

Objective To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery,The Second Affiliated Hospital,Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females,with an average age of 37.2 years(from 18 to 65 years).Twelve left and 16 right sides were affected.According to Myerson's three-column classification,one case was medial column injury(type A),4 ones middle column injury(type B),7 ones medial plus middle columns injury and 16 ones three-column injury.Medial column arthrodesis was conducted in 7,middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17.The American Orthopaedic Foot and Ankle Society(AOFAS)midfoot score and visual analogue scale(VAS)were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain.The operation-related complications were recorded.Results All patients were followed up for an average of 35.6 months(from 18 to 60 months).The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1±7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up(both P<0.001).The wounds healed in 28 patients,3 of whom had postoperative wound exudation but responded to dressing change.There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis.The internal fixation was removed in 5 patients at about one year after arthrodesis.Conclusion Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.