经皮闭合复位内固定治疗隐匿性Lisfranc损伤

Percutaneous reduction and internal fixation for subtle Lisfranc injuries

[目的]评介经皮闭合复位内固定治疗隐匿性Lisfranc损伤患者的疗效。[方法] 2012年1月～2015年12月,选择符合条件的32例隐匿性Lisfranc损伤患者纳入研究,其中新鲜损伤19例,陈旧性损伤(外伤后超过6周) 13例,均为单足,平均年龄(36.23±5.14)岁。术后末次随访时采用美国足踝外科协会AOFAS评分量表进行评估,测定术前及术后3个月站立相足底平均压力值。[结果] 32例患者随访12～22个月,平均(16.17±2.41)个月,所有患者术后均无内固定物失效、再次骨折脱位等并发症发生。末次随访时新鲜损伤组与陈旧损伤组的AOFAS评价均较术前显著增加,差异有统计学意义(P<0.01),但相应时间点两组间差异无统计学意义(P>0.05)。此外,新鲜损伤组、陈旧损伤组治疗后3个月足底压力载荷均较术前显著增加(P<0.01),但相时间点两组间差异无统计学意义(P>0.05)。[结论]对隐匿性Lisfranc损伤的治疗,经皮闭合复位重建足弓、恢复足内外侧纵弓及横弓解剖形态,牢固内固定均可以取得较好的治疗效果。

[Objective]To evaluate clinical outcomes of subtle Lisfranc joint injuries treated with percutaneous reduction and internal fixation.[Methods]From January 2012 to December 2015,32 patients with subtle Lisfranc injuries were enrolled into this study.The patients aged(36.23±5.14)years on average,and suffered from unilateral injuries,including 19 cases of fresh injuries and 13 cases of chronic injuries(more than 6 weeks after injury),received percutaneous reduction and internal fixation.The AOFAS score was used to evaluate the clinical outcomes,and the pressure load under the foot before and 3 months after surgery were measured.[Results]All the 32 patients were followed up for 12~22 months with a mean of(16.17±2.41)months.No complications such as internal fixation failure,re-fracture and dislocation,happened in anyone of them.The AOFAS score significantly increased in both groups as time went on(P<0.01),although no a significant difference was noticed between the two groups at any corresponding time points(P>0.05).In addition,the pressure load under the foot at 3 months postoperatively proved significantly greater than that before operation in both groups(P<0.01),without a statistical difference between the two groups at any matching time point(P>0.05).[Conclusion]For the subtle Lisfranc injury,this closed reduction and internal fixation does restore the anatomy of the arch of foot,and achieve satisfactory clinical results.