摘要
目的 探讨选择性跖跗关节融合术治疗不伴有明显创伤性骨关节炎(post-traumatic osteoarthritis,PTOA)的陈旧性Lisfranc损伤的临床效果。方法 回顾性分析2013年6月-2021年6月成都市郫都区人民医院采用选择性跖跗关节融合术治疗的不伴有明显PTOA的陈旧性Lisfranc损伤患者的临床资料。比较患者术前及末次随访的视觉模拟评分法(Visual Analogue Scale,VAS)评分、美国骨科足踝外科协会(American Orthopedic Foot Ankle Society,AOFAS)中足评分、健康调查量表12(Short Form 12,SF-12)评分的改善情况。结果 最终纳入17例(17足)不伴有明显PTOA的陈旧性Lisfranc损伤患者,其中男12例,女5例。所有患者均顺利完成手术,术后未出现切口愈合不良、软组织缺血坏死、深部和浅表感染等并发症。所有患者平均随访22.6个月(12~36个月)。术后3个月随访X线片显示所有患者融合端均已骨性愈合,患者满意度为94.1%。相比术前,患者末次随访时的VAS评分[(6.0±0.3)vs.(0.8±0.2)分]、AOFAS评分[(50.5±1.5)vs.(86.5±0.9)分]、SF-12生理评分[(21.9±0.6)vs.(46.1±0.5)分]、SF-12心理评分[(31.1±0.8)vs.(47.3±0.7)分]均有改善(P<0.05)。结论 对于不伴有明显PTOA的陈旧性Lisfranc损伤,选择性跖跗关节融合术能够在恢复中足力线和稳定性的同时,避免全足融合后的僵硬,可保留中足功能,患者满意度高。
Objective To investigate the clinical efficacy of selective tarsometatarsal arthrodesis for old Lisfranc injury without significant post-traumatic osteoarthritis(PTOA). Methods The clinical data of patients with old Lisfranc injury without significant PTOA who were treated by selective tarsometatarsal arthrodesis at Chengdu Pidu District People’s Hospital between June 2013 and June 2021 were analyzed retrospectively. The improvement of patients’ Visual Analogue Scale(VAS) score, American Orthopedic Foot Ankle Society(AOFAS) midfoot score and Short Form 12(SF-12) score before surgery and at the final follow-up were compared. Results Seventeen old Lisfranc injury patients(17 feet) without significant PTOA were finally recorded, including 12 males and 5 females. All patients completed the surgery successfully, and the surgical incisions healed smoothly after surgery without complications such as poor incision healing, soft tissue ischemic necrosis, and deep and superficial infections. All patients were followed up for an average of 22.6 months(12 to 36 months). Three months after surgery, follow-up X-ray films showed bony healing of the fused ends in all patients, and the patient satisfaction was 94.1%. Compared with the preoperative scores, VAS score(6.0±0.3 vs. 0.8±0.2), AOFAS score(50.5±1.5 vs. 86.5±0.9), SF-12 physiological score(21.9±0.6 vs. 46.1±0.5) and SF-12 psychological score(31.1±0.8 vs. 47.3±0.7) at the last follow-up improved(P<0.05). Conclusion Selective tarsometatarsal arthrodesis for the old Lisfranc injuries without significant PTOA can restore the midfoot force lines and stability, avoid stiffness after full feet fusion, preserve midfoot function, and improve patient satisfaction.
作者
邓伟
李宗蔚
王胜涛
蔡杰勇
张瀚文
殷勇
DENG Wei;LI Zongwei;WANG Shengtao;CAI Jieyong;ZHANG Hanwen;YIN Yong(Department of Orthopedics,Pidu District People's Hospital,the Third Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan611730,P.R.China;Department of Foot and Ankle Surgery,Mianyang Orthopaedic Hospital,Mianyang,Sichuan 621000,P.R.China)
出处
《华西医学》
CAS
2022年第10期1487-1492,共6页
West China Medical Journal
基金
四川省医学会骨科(尚安通)专项科研课题(2021SAT05)。