中空螺钉与钢板螺钉对Lisfranc损伤患者术后疼痛及关节功能的改善对比

Comparison of postoperative pain and joint function improvement between hollow screw and plate screw in patients with Lisfranc injury

目的比较中空螺钉和钢板螺钉固定治疗Lisfranc损伤的临床疗效。方法前瞻性研究选择南京市溧水区人民医院2019年1月至2022年1月骨科收治的60例需要手术内固定治疗的Lisfranc损伤患者,其中男性36例,女性24例;年龄18~65岁,平均年龄42.45岁;身体质量指数(BMI)17.02~27.33 kg/m^(2),平均BMI 22.63 kg/m^(2);身高157.15~184.67 cm,平均身高168.84 cm;高处坠落8例,重物砸伤26例,交通事故21例,其他原因5例;A1型9例,A2型7例,B1型18例,B2型14例,C1型6例,C2型6例;左足36例,右足24例。采用数字随机法将患者分为中空螺钉组(采用中空螺钉固定)和钢板螺钉组(使用钢板螺钉固定)。治疗后,观察和比较两组患者治疗前后视觉模拟量表(VAS)评分、美国足与踝关节协会(AOFAS)踝与后足功能评分及术后近期和远期并发症的发生率。结果术后全部患者均随访12个月。相比治疗前,两组患者VAS在治疗后都有明显下降,差异有统计学意义(P<0.05);术后6个月VAS评分中空螺钉组稍高于钢板螺钉组(1.15分±0.21分vs 1.01分±0.25分),差异具有统计学意义(P<0.05)。治疗后两组患者AOFAS评分均随着时间明显增高,且术后3个月、术后6个月和术后1年钢板螺钉组AOFAS评分明显高于中空螺钉组[(57.15±6.77)分vs(53.02±6.23)分、(67.97±6.02)分vs(64.74±6.43)分、(79.53±8.68)分vs(75.64±7.05)分],差异有统计学意义(P<0.05)。钢板螺钉组优良率明显高于中空螺钉组(83.33%vs 70.00%);两组患者近期并发症钢板螺钉组(13.33%)明显高于中空螺钉组(6.67%),但差异无统计学意义(P>0.05)。随访至1年后,远期并发症钢板螺钉组(20.00%)明显高于中空螺钉组(3.33%),差异具有统计学意义(P<0.05)。结论中空螺钉治疗Lisfranc损伤具有创伤小、减少患者术后疼痛和并发症发生等优点,但钢板螺钉治疗对Lisfranc关节的稳固性较好,患者术后功能恢复快。

Objective To compare the clinical efficacy of hollow screw and plate screw fixation in the treatment of Lisfranc injury.Methods From January 2019 to January 2022,a total of 60 patients with Lisfranc injury requiring surgical internal fixation were prospectively enrolled,which included 36 males and 24 females,aged 18-65 years old with mean age of 42.45 years old;body mass index(BMI)was 17.02-27.33 kg/m^(2) with mean BMI of 22.63 kg/m^(2);height was 157.15-184.67 cm with mean height of 168.84 cm.There were 8 cases of falling accident,26 of heavy object injury,21 of traffic accident and 5 of other causes.There were 9 cases of A1 type,7 of A2 type,18 of B1 type,14 of B2 type,6 of C1 type and 6 of C2 type;36 cases of left foot and 24 of right foot injury.All of them were divided into hollow screw group(fixed with hollow screw)and plate screw group(fixed with plate screw)by digital random method.The visual analogue scale(VAS)score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot function score before and after treatment,and the incidence of short-term and long-term complications after operation between 2 groups were observed and compared.Results All patients were followed up for 12 months.The VAS of 2 groups post treatment was statistically significantly lower than that before treatment(P<0.05).The VAS score of hollow screw group was slightly higher than that of plate screw group 6 months post operation[(1.15±0.21)scores vs(1.01±0.25)scores],and the difference was statistically significant.After treatment,the AOFAS score of 2 groups increased significantly with prolonged time,and the AOFAS scores of plate screw group were statistically significantly higher than those of hollow screw group at 3 months,6 months and 1 year after operation[(57.15±6.77)scores vs(53.02±6.23)scores,(67.97±6.02)scores vs(64.74±6.43)scores,(79.53±8.68)scores vs(75.64±7.05)scores.P<0.05].The excellent and good rate of plate screw group was significantly higher than that of hollow screw group(83.33%vs 70.00%).The recent complications of 2 groups were significantly higher in plate screw group(13.33%)than in hollow screw group(6.67%),but the difference was no statistically significant(P<0.05).Conclusion It is demonstrated that hollow screw treatment of Lisfranc injury showed the advantages of less trauma,less postoperative pain and complications,while plate screw treatment showed good stability to Lisfranc joint,and the postoperative functional recovery of patients is fast.