锁定加压钢板联合空心钉及克氏针治疗跖跗关节损伤39例

39 Cases of Clinical Report on Locking Compression Plate Combined with Cannulated Screw and Kirschner Wire on the Treatment of Lisfranc Injury

目的:评估锁定加压钢板(LCP)联合空心钉及克氏针治疗跖跗关节损伤(Lisfranc损伤)的临床疗效。方法:选取2016年6月至2020年5月收治的跖跗关节损伤患者39例,采用锁定加压钢板联合空心钉及克氏针内固定治疗。术后定期影像学检查并观察并发症情况,末次随访时依据美国足踝关节协会(AOFAS)评分系统对患足功能进行评估。结果:所有纳入患者均获得完整随访,随访时间为15~18个月,平均为17.2个月。根据Myerson分型:A型17足,B型12足,C型10足。所有患者均未发生内固定物松动或断裂、骨折再次移位、骨折不愈合、伤口感染、皮缘坏死、慢性骨髓炎等并发症,均为一期愈合。末次随访时,患足功能评定为“可”的患者中1例出现足弓塌陷,诊断为扁平足;2例跖跗关节疼痛,诊断为创伤性骨关节炎,需口服非甾体类抗炎药物(NSAID)止痛。术后15个月依据美国足踝关节协会中足评分标准对39例患者患足的功能进行评定,AOFAS评分(90~100分为优,80~89分为良,70~79分为可,<70分为差)结果:优30例,良6例,可3例,差0例,患足功能恢复优良率为92.31%。结论:通过锁定加压钢板联合空心钉及克氏针治疗跖跗关节损伤达到解剖复位,钢板及螺钉放置简便,固定可靠,临床疗效显著。

Objective:To appraise the clinical efficacy of locking compression plate(LCP) combined with cannulated screw on the treatment of Lisfranc injury. Methods:Thirty-nine cases of Lisfranc injury treated from June 2016 to May 2020 were selected and treated with locking compression plate combined with cannulated screw internal fixation. Postoperative imaging examinations were performed regularly and complications were observed. At the last follow-up, the function of the affected foot was evaluated according to the American Orthopedic Foot and Ankle Society(AOFAS) scoring system. Results:All patients were followed up for 15 to 18 months, with an average of 17.2 months. According to Myerson, type A has 17 feet, type B has 12 feet and Type C has 10 feet. No complications such as internal fixation loosening or fracture, fracture redisplacement, fracture nonunion, wound infection, cutaneous necrosis, and chronic osteomyelitis occurred in all patients, all of which were primary healing. At the last follow-up, among the patients with “OK” foot function, 1 case had arch collapse and was diagnosed as flat foot, and 2 cases had tarsal joint pain and was diagnosed as traumatic osteoarthritis, requiring oral nonsteroidal antiinflammatory drugs(NSAID) for pain relief. The function of the affected feet of 39 patients was evaluated 15 months after surgery according to the AOFAS medium foot scale. AOFAS score: 90 to 100 is excellent, 80 to 89 is good, 70 to 79 is fair, <70 is poor. Among them, 30 cases were excellent, 6 cases were good, 3 cases were fair, and 0 case was bad. The excellent and good rate of functional recovery of affected foot was 92.31%. Conclusion:The treatment of Lisfranc injury by locking compression plate combined with cannulated screw had good reduction, easy placement of plate and screw, reliable fixation, and significant clinical efficacy.