经改良三切口入路手术治疗三柱Lisfranc损伤

A comparative study of the use of a modified three-incision approach to treat three-column Lisfranc injuries

目的比较经改良三切口入路与经典双切口入路治疗三柱Lisfranc损伤的临床疗效。方法回顾性选取2017年12月至2020年10月收治的61例三柱Lisfranc损伤病例进行研究。其中观察组33例,男性26例,女性7例,年龄(39.2±12.7)岁(18~59岁);对照组28例,男性20例,女性8例,年龄(38.8±13.9)岁(18~60岁)。观察组采用改良三切口入路进行切开复位内固定,对照组采用经典双切口入路行切开复位内固定术。比较两组患者手术时间、术中X线透视次数、术后引流量、术后并发症情况,评价两组患者末次随访Maryland足部评分。结果观察组和对照组手术时间分别为(91.5±10.7)min和(86.9±5.3)min,两组间存在差异(P<0.05);观察组和对照组术中X线透视分别为(5.4±1.9)次和(7.6±3.6)次,两组间有差异(P<0.05);观察组和对照组术后引流量分别为(21.2±24.3)m L和(21.8±1.5)mL,两组间无差异(P>0.05);观察组发生并发症1例,对照组为6例,两组间存在差异(P<0.05)。观察组和对照组随访时间分别为(14.5±1.6)个月和(14.6±1.6)个月,在末次随访时使用Maryland足部功能评分进行评估,观察组和对照组功能总分分别为(90.9±8.3)分和(91.9±6.4)分,两组间无统计学差异(P>0.05);观察组和对照组优良率分别为90.9%和89.3%,两组间无差异(P>0.05)。结论经改良的三切口入路手术治疗三柱Lisfranc损伤术中暴露好,术中X线透视次数少,术后并发症少,患足功能满意,值得进一步推广使用。

Objective To compare the clinical outcome between the modified three-incision approach and the classic double-incision approach for the treatment of three-column Lisfranc injuries.Methods A retrospective analysis was performed of 61 patients who suffered three-column Lisfranc injury between December 2017 and October 2020.There were 33 patients in the observation group,comprising 26 males and seven females aged 18–59 years(39.2±12.7),and 28 patients in the control group,comprising 20 males and eight females aged 18–60 years(38.8±13.9).Patients in the observation group were treated by the modified three-incision approach while those in the control group were managed by the classic doubleincision approach.The surgery duration,intraoperative fluoroscopy times,the volume of postoperative wound drainage and incidence of postoperative complications were compared;the Maryland foot function was also evaluated and compared.Results The surgery durations of the observation group and control group were significantly different at(91.5±10.7)and(86.9±5.3)minutes,respectively(P<0.05);the intraoperative fluoroscopy times of the observation and control group were also significantly different at(5.4±1.9)and(7.6±3.6)(P<0.05).However,the volume of postoperative wound drainage of the observation group and the control group were not significantly different at(21.2±24.3)mL and(21.8±1.5)mL,respectively(P>0.05).The number of cases with postoperative complications were one in the observation group and six in the control group,which was significant difference(P<0.05).The follow-up times of the observation group and control group were 12–18(14.5±1.6)months and 12–17(14.6±1.6)months,respectively.The Maryland foot function scores at the end of the follow-up showed no significant difference,with scores of(90.9±8.3)and(91.9±6.4)in the observation group and control group,respectively(P>0.05);however the excellent and good rates of the observation group(90.9%)were superior to those of the control group(89.3%).Conclusion The modified three-incision approach to treat three-column Lisfranc injury,demonstrating advantages of better exposure,fewer fluoroscopy times,fewer postoperative complications,and satisfactory foot function,is worth being widely used.