Lisfranc损伤手术治疗并发症的研究进展

对于Lisfranc损伤的手术治疗，临床已有很多成熟的方案，但对于不同术式以及内固定的选择存在争议，没有高度标准化的手术方案。又因Lisfranc损伤本身的隐匿性、复杂性，对临床诊治提出了较高的要求。不当的术式选择和内固定选择都有可能引起术后并发症。本文通过回顾近年关于Lisfranc损伤手术治疗的文献中出现的并发症情况，以期对临床选择最佳术式提供参考。     

Is Routine Hardware Removal Following Open Reduction Internal Fixation of Tarsometatarsal Joint Fracture/Dislocation Necessary?

Open reduction internal fixation (ORIF) is an accepted treatment for displaced tarsometatarsal joint (TMTJ) fracture dislocations. In general, hardware is routinely removed after 4 months to allow restoration of joint motion and avoid complications of hardware failure. Because few studies report outcomes of TMTJ fractures with retained hardware, there is little consensus regarding the optimal time for hardware removal or if hardware retention leads to adverse outcomes. We retrospectively reviewed the radiographic outcomes of retained hardware after ORIF of TMTJ fractures/dislocations in 61 patients. The mean age at the time of operation was 37.3 ± 14.9 years. ORIF was performed with 3.5 fully threaded cortical screws. Assessment of clinical and radiographic results was performed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months after surgical treatment. Out of the 61 patients that were included in this study, only 2 demographic variables demonstrated a trend for an adverse outcome. Older age correlated with lost reduction and elevated body mass index correlated with hardware failure. The presence of diabetes was correlated with an increased risk of postoperative infection but not hardware failure. During our follow-up period there were 49 patients (80.3 %) without failure of fixation. In conclusion, our study suggests that routine removal of hardware following open reduction and internal fixation of Lisfranc injuries in patients may not be necessary.     

跖跗关节骨折手术中空心螺钉固定对治疗效果及术后并发症的影响分析

目的探讨跖跗关节骨折手术中空心螺钉固定对治疗效果以及术后并发症情况的影响。方法选择跖跗关节骨折患者90例进行临床研究,按照随机数字表法将其分为三组,各30例,分别采取背侧钢板内固定、空心螺钉单次贯穿及空心螺钉2次贯穿关节面内固定治疗。分析三组患者第2跖骨底间的平移位移及外展加载位移,分析比较其生物力学效果、AOFAS评分及术后的并发症发生情况。结果空心螺钉单次贯穿固定组的轴向加载位移及外展加载位移均最小;空心螺钉单次贯穿固定组患者骨折愈合时间在三组患者中最短,AOFAS评分在三组患者中最高;且空心螺钉2次贯穿固定组的创伤性关节炎发生率最高,差异有统计学意义(P0.05)。结论空心螺钉固定中,特别是空心螺钉单次贯穿固定能够有效保证踝关节暴露充分,融合接触面积大,而且手术操作方便,固定效果牢固,是治疗跖跗关节骨折病损的有效方法,值得临床推荐。