摘要
目的探讨撑开器辅助复位治疗合并足外侧柱压缩性骨折的Lisfranc损伤的疗效。方法回顾性分析2014年5月至2017年3月期间郑州市骨科医院足踝外科收治的18例(18足)合并足外侧柱压缩性骨折的Lisfranc损伤患者资料。男10例,女8例;右侧11例,左侧7例;年龄为25~65岁,平均38.4岁。合并骰骨压缩性骨折12例,合并跟骨前突压缩性骨折6例。根据Chiodo-Myerson分型:三柱损伤13例,中间柱和外侧柱同时损伤3例,内侧柱和外侧柱同时损伤2例。所有患者均为闭合性损伤,待足部软组织条件允许后行切开撑开器辅助复位微型锁定钢板内固定术。记录末次随访时患者的美国足踝外科协会(AOFAS)踝与后足评分、疼痛视觉模拟评分(VAS)及随访期间并发症的发生情况等。结果18例患者术后获1~4年(平均2年)随访。末次随访时采用AOFAS踝与后足评分为55~96分,平均80.4分;疼痛VAS评分为0~6分,平均1.5分。影像学上中足出现退行性改变的患者有10例,其中2例患者出现持续疼痛,经保守治疗无效后行关节融合术,疼痛消失。1例患者出现腓肠皮神经损伤症状,口服营养神经药物半年后症状消失。其余患者未见皮肤坏死、感染、内固定失效等并发症发生。结论切开撑开器辅助复位外侧柱微型锁定钢板固定、必要时植骨治疗合并外侧柱压缩性骨折的Lisfranc损伤,可有效恢复外侧柱长度、效果确切,是一种可靠的治疗方法。
Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column. Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column. They were 10 males and 8 females, with an average age of 38.4 years (from 25 to 65 years). The injury involved the right foot in 11 cases and the left foot in 7. Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process. According to the Chiodo-Myerson classification, there were 13 cases of three-column injury, 3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury. All the injuries were closed. After the condition of foot soft tissues permitted, open reduction assisted by a distractor and internal fixation with a mini locking plate was performed. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up. Results The 18 patients were followed up for one to 4 years (average, 2 years). Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average, 80.4 points);their VAS ranged from 0 to 6 points (average, 1.5 points). Radiographic evidence of degeneration was noted in 10 patients. Of them, 2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year. No such complication as skin necrosis, infection or implant failure occurred in other patients. Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate, combined with bone graft if necessary, is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column, because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects.
作者
尚林
王翔宇
王爱国
贾光辉
李琦
张小龙
马富强
Shang Lin;Wang Xiangyu;Wang Aiguo;Jia Guanghui;Li Qi;Zhang Xiaolong;Ma Fuqiang(Department of Foot and Ankle Surgery,Zhengzhou Orthopaedics Hospital,Zhengzhou 450052,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第6期535-539,共5页
Chinese Journal of Orthopaedic Trauma
关键词
骰骨
跟骨
足关节
骨折
骨折固定术
内
Cuboid bone
Calcaneus
Foot joints
Fractures, bone
Fracture fixation, internal
