切开复位双重加压螺钉固定治疗跖跗关节损伤

[目的]探讨切开复位双重加压螺钉固定治疗跖跗关节损伤的临床疗效.[方法]回顾性分析2007年9月～2010年10月间治疗的67例跖跗关节损伤患者,其中35例损伤患者采用切开复位双重加压螺钉或结合克氏针固定治疗,32例患者采用空心钉或结合克氏针固定治疗.男53例,女14例,年龄18 ～60岁,平均32岁.根据Myerson分型:A型15例,B型36例,C型16例.根据美国矫形足踝协会(AOFAS)中足评分标准评价比较两种方法的治疗效果.[结果]所有患者均获得随访,平均随访18个月(12～30个月).双重加压螺钉治疗组术后平均AO-FAS中足评分81.7分(56 ～98分),术后未发生感染、创伤性关节炎、螺钉断裂等并发症；空心钉治疗组术后平均AOFAS中足评分78.6分(45 ～96分),2例发生伤口感染,2例未获得解剖复位,二期行关节融合术.两种治疗方法AOFAS评分差异无统计学意义(t=1.056,P＞0.05).[结论]切开复位双重加压螺钉固定治疗跖跗关节损伤与空心螺钉治疗效果相似,由于双重加压螺钉能更好达到解剖复位和坚强固定,切开复位双重加压螺钉固定治疗跖跗关节损伤是一种疗效满意的方法.

Treatment of Lisfranc injury with open reduction and ideal compression screw fixation

[Objective]To investigate the clinical effect of open reduction and ideal compression screw(ICOS) fixation in the treatment of Lisfranc injury.[Method]From September 2007 to October 2010,sixty-seven cases of Lisfranc injury were reviewed retrospectively,including thirty-five cases treated with open reduction and ideal compression screw or combined Kirschner wires fixation and thirty-two cases treated with cannulated screw or combined Kirschner wires fixation.There were fifty-three males and fourteen females with an average age of 32 years(range,18-60 years).According to Myerson classification,there were fifteen patients with type A,thirty-six with type B,sixteen with type C.The postoperative results of the two methods were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) mid-foot score system.[Result]All the patients were followed up for average eighteen months(range,12-30 months).The mean AOFAS score was 81.7 points(range,56-98 points) in group using the ideal compression screw fixation.There was no infection,posttraumatic osteoarthritis,or screw broken in postoperation.While the mean AOFAS score was 78.6 points(range,45-96 points) in the group using cannulated screw fixation.There were two patients with wound infection and two patients with nonanatomic reduction leading to arthodesis finally.No significant difference in the AOFAS score was found for the two methods of treatment(t=1.056,P>0.05).[Conclusion]There are similar results in the treatment of Lisfranc injury with open reduction using ideal compression screw fixation or cannulated screw.Open reduction and ideal compression screw fixation can achieve better anatomical reduction and stable fixation.It is a good choice for the treatment of Lisfranc injury and can obtain satisfactory clinical results.