累及舟骨、楔骨或舟楔关节的Lisfranc损伤的外科治疗

Surgical treatment of Lisfranc injuries involving the navicular,cuneiform or navicularcuneiform joints

目的:探讨累及舟骨、楔骨或舟楔关节的Lisfranc损伤的特点及治疗手段。方法:回顾性分析2017年11月至2022年11月收治的14例Lisfranc损伤患者的临床资料。其中男9例,女5例,年龄22~58岁,平均(35.6±8.7)岁。包括舟楔关节脱位5例,舟骨骨折3例,内侧楔骨骨折6例。所有患者均采用切开复位内固定术进行治疗。术后观察患者切口感染、足部疼痛或感觉麻木等手术并发症发生情况。术前及末次随访时记录患者疼痛视觉模拟评分(VAS),同时末次随访时应用美国足踝外科协会(AOFAS)中足评分评估患者足部功能。结果:14例患者随访22.5(14.5,32.0)个月(4~53个月)。术后仅1例患者出现足背部麻木,其余患者均未发生手术并发症。末次随访时疼痛VAS评分为1.5(1.0,2.0)分,低于术前的(7.4±0.8)分,且差异有统计学意义(U=0,P<0.05);末次随访时患者AOFAS评分达到(75.4±10.3)分,运动功能显著改善,优良率为71.4%(10/14),且负重后患者疼痛明显减轻。结论:累及舟骨、楔骨或舟楔关节的Lisfranc损伤有别于累及第1跖楔关节的Lisfranc损伤,处理时需要根据暴力损伤的走行方向确定损伤起点,从而制定具体的手术方案,以免遗漏损伤部位而影响预后。

Objective:To investigate the characteristics and treatment modalities of Lisfranc injuries involving the navicular,cuneiform or navicular-cuneiform joints.Methods:A retrospective analysis was conducted on the clinical data of 14 patients with Lisfranc injuries admitted from November 2017 to November 2022.This cohort included 9 males and 5 females,aged between 22 and 58 years,with a mean age of(35.6±8.7)years.The injuries included 5 cases of navicular-cuneiform joint dislocation,3 cases of navicular fracture,and 6 cases of medial cuneiform fracture.All patients underwent open reduction and internal fixation.Postoperative complications such as incision infection,foot pain,or sensory numbness were observed.Pain visual analogue scale(VAS)scores were recorded preoperatively and at the final follow-up,and foot function was assessed using the American Orthopedic Foot and Ankle Society(AOFAS)midfoot score at the final follow-up.Results:The 14 patients were followed up for 4 to 53 months,with an average follow-up period of 22.5(14.5,32.0)months.Only one patient experienced numbness on the dorsum of the foot postoperatively,and no other surgical complications occurred in the remaining patients.At the final follow-up,the pain VAS score 1.5(1.0,2.0)was significantly lower than the preoperative score(7.4±0.8)(U=0,P<0.05).The AOFAS score at the final follow-up reached(75.4±10.3),indicating significant recovery of motor function and notably reduced pain upon weight bearing.Conclusions:Lisfranc injuries involving the navicular,cuneiform or navicular-cuneiform joints differ from traditional Lisfranc injuries involving the first metatarsocuneiform joint.Treatment should be based on the direction of the injury force to determine the starting point of the injury,thus developing a specific surgical plan to avoid missing injured areas that may affect the prognosis.