切开复位内固定治疗Lisfranc关节损伤的体会

目的探讨切开复位内固定治疗Lisfranc关节损伤的中短期疗效。方法回顾性分析自2010-01—2013-12诊治的15例Lisfranc关节损伤,分别采用切开复位克氏针、空心钉及背侧钢板内固定,根据美国足踝骨科协会(AOFAS)评分标准对患足术后功能进行评价。结果所有患者均获得随访12~24个月,平均18个月。骨折均达到一期愈合,无皮肤坏死、伤口感染、内固定物断裂、复位丢失等并发症。所有患者均达到解剖复位,根据AOFAS评分标准,平均得分85分,优5例,良9例,可1例。结论切开复位内固定治疗Lisfranc关节损伤可获得良好的中短期疗效满意,能有效恢复患足功能,减少致残率。     

伴第2跖骨基底部粉碎的Lisfranc损伤的手术治疗

目的 :探讨切开复位内固定治疗伴第2跖骨基底部粉碎的Lisfranc损伤的临床疗效。方法:选取2007年3月至2012年6月伴第2跖骨基底部粉碎的Lisfranc损伤患者7例,男5例,女2例;年龄22~51岁,平均42岁;扭伤4例,交通伤3例。Myerson分型:A型1足,B型3足,C型3足。在手术内固定同时,用克氏针从内侧楔骨至第2跖骨基底部固定Lisfranc韧带。术后采用美国足踝外科协会(AOFAS)足评分标准进行功能评估;术前、术后摄X线正位、侧位、斜位片及CT检查,进行影像学评估。结果:所有患者获得随访,时间12~20个月,平均16.8个月。末次随访AOFAS评分(86.1±5.5)分;优3例,良3例,一般1例。所有切口Ⅰ期愈合,未见皮肤坏死,感染,克氏针松动、断裂等并发症。结论:在手术内固定同时,用克氏针固定伴第2跖骨基底部粉碎的Lisfranc韧带损伤,有良好的临床疗效,可避免行关节融合术。     

切开复位内固定治疗Lisfranc关节损伤临床疗效观察

目的探讨切开复位内固定治疗Lisfranc关节损伤的临床疗效。方法采用切开复位空心钉内固定治疗Lisfranc关节损伤16例(19足),末次随访时采用AOFAS评分评估术后疗效。结果 16例均获随访3~20个月,平均13个月。末次随访时采用AOFAS评分评估疗效:优9足,良5足,可3足,差2足,优良率73.7%。结论切开复位空心钉内固定治疗Lisfranc关节损伤疗效显著,能够重建跖跗关节复合体的稳定性;损伤程度、术中复位质量与疗效密切相关。     

切开复位内固定治疗Lisfranc损伤疗效观察

目的探讨采用切开复位内固定术治疗Lisfranc损伤的可行性和疗效。方法自2012-01—2013-09采用切开复位内固定术治疗15例Lisfranc损伤,Lisfranc关节内侧柱和中间柱用空心钉刚性固定,外侧柱行克氏针弹性固定。术后采用AOFAS评分标准进行足踝功能评估。结果本组术后X线片显示14例获得解剖复位。术后所有患者获得随访2~19个月,平均11个月。末次随访时AOFAS足踝评分:优9例,良4例,可2例。6例在随访过程中发现Lisfranc关节骨性关节炎,其中1例久行后出现跖跗关节处疼痛。结论切开复位内固定治疗Lisfranc损伤疗效满意,术中解剖复位、稳定固定,以及确保后期复位不丢失是获得满意疗效的关键。     

切开复位钢板联合克氏针内固定治疗Lisfranc损伤

目的 探讨Lisfranc损伤应用切开复位钢板联合克氏针内固定方法治疗的临床效果。方法 2015年12月-2021年3月共收治Lisfranc损伤患者11例,应用切开复位钢板联合克氏针内固定方法治疗。所有患者均消肿后择期手术,术后行AOFAS评分评定疗效。结果 术后患者均获随访,随访时间4个月~5年,平均1.5年,AOFAS评分61~97分,平均83.5分,优良率为82.3%。术后1例切口边缘皮肤坏死,换药后愈合;1例发生创伤性关节炎。切口无感染,均一期愈合;脱位完全复位,3~4个月后复查骨折愈合良好。结论 切开解剖复位,钢板联合克氏针固定相对稳定,符合Lisfranc力学原理,该手术方法治疗Lisfranc损伤临床效果满意。     

切开复位跨关节钢板内固定治疗Lisfranc损伤

目的探讨切开复位跨关节钢板内固定治疗Lisfranc损伤的疗效。方法对47例Lisfranc损伤患者采用切开复位跨关节钢板内固定治疗,根据AOFAS中足评分评价疗效。结果 47例均获得随访,时间12~40个月。末次随记时根据AOFAS中足评分对患者术后足功能进行评定:好26例,较好20例,差1例。随访中发生螺钉断裂1例,克氏针滑脱2例,创伤性关节炎1例。结论解剖复位、稳定固定是Lisfranc损伤获得良好预后的关键。     

闭合复位结合切开复位内固定治疗Lisfranc关节损伤的疗效分析

目的评价采用闭合复位结合切开复位内固定治疗Lisfranc关节损伤的效果。方法应用闭合复位结合切开复位方法,选用空心钉、克氏针为内固定材料,对52例58侧Lisfranc关节损伤患者进行治疗。结果术后随访6～32个月,平均19个月。采用美国足踝外科协会(AOFAS)中足评分标准评定功能:优15侧,良28侧,可10侧,劣5侧。结论采用闭合复位结合切开复位内固定治疗Lisfranc关节损伤可取得良好效果。     

切开复位内固定治疗Lisfranc关节损伤

[目的]总结切开复位内固定治疗Lisfranc关节损伤的临床经验,提高治疗Lisfranc关节损伤的水平.[方法]自2003年7月-2007年10月间,本院共收治30例33侧Lisfranc关节损伤的病人,采用切开复位内固定术.损伤按Quenu-kuss分型,A型5例,B型25例,C型3例.手术采用1～2个足背侧纵行切口,复位后用空心螺钉或克氏针固定.[结果]术后平均随访36个月(6～45个月),根据Maryland足部功能平分(MFS)评估疗效,优良率为76.2%.[结论]切开复位内固定治疗Lisfranc关节损伤,可以取得良好的效果.     

一期切开复位内固定治疗Lisfranc关节损伤疗效分析

目的探讨一期切开复位内固定治疗Lisfranc关节损伤的临床疗效。方法对30例Lisfranc关节损伤一期行切开复位内固定手术,根据AOFAS功能评分评价术后功能恢复情况。结果30例均获随访6～12个月,平均10．5个月。切口均一期愈合,未发生感染。所有患者足弓形态基本恢复正常,步态基本正常。AOFAS评分：优23例,良3例,可4例,优良率86．7％。结论一期切开复位内固定是治疗Lisfranc关节损伤的有效方法。     

切开复位内固定治疗Lisfranc损伤12例

目的 探讨切开复位内固定治疗Lisfranc关节损伤的临床疗效. 方法 选取2003年至2012年,12例Lisfranc关节损伤患者,并采用切开复位内固定方法进行治疗,内固定材料选择螺丝钉、克氏针及微型钢板,并根据损伤的程度单独或联合使用,依据美国足踝外科协会（AOFAS）评分标准对患足术后的功能进行评定. 结果 12例随访0.5 ～3年,其中优8例,良2例,一般1例,差1例. 结论 切开复位内固定治疗Lisfranc关节损伤的临床效果良好,而解剖复位及稳定的固定是获得良好预后的关键.     

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.     

Percutaneous fixation of Lisfranc joint injuries: A systematic review of the literature

ObjectiveThe aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation.MethodsWe searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well.ResultsAverage AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant.ConclusionPercutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved.Level of EvidenceLevel III, Therapeutic Study.     

Persistent instability in pure ligamentous Lisfranc joint injuries

IntroductionLisfranc injuries refer to a specific group of injuries which lead to instability of the tarsalmetatarsal joint. Our hypothesis is that persistent instability is permanent and asymptomatic in subtle unstable injuries of the medial column which have been fixed percutaneously.ObjectiveTo describe the persistent instability of pure ligamentous Lisfranc joint injuries treated with anatomic reduction and percutaneous screws fixation by comparative radiographs of both feet.Materials and methodsBetween 2014 and 2018, 14 patients diagnosed with subtle unstable Lisfranc injury were evaluated. Indications for surgery included widening (diastasis) greater than 2 mm between the first and second metatarsal bases, and subluxation greater than 1 mm of a metatarsal base from its respective tarsal bone.ResultsPersistent instability was found on the stress radiographs of 11 patients (78.57% 95% CI: 48.60–95.07%) but without clinical connotations. The average AOFAS score evaluated at 18 months post-operatively was of 97.14 (SD ± 4.68) points. The median follow-up was 24 (RIQ: 18–24) months. In all patients, anatomical reduction on radiographs was evident.ConclusionWe observed a persistent instability of the Lisfranc joint, without clinical connotations.Subtle unstable Lisfranc injuries treated with percutaneous screw fixation have a good clinical and functional outcome.Level of evidence: IV.     

早期切开减压并螺钉固定治疗Lisfranc损伤并足骨筋膜室综合征

目的:探讨早期切开减压并螺钉固定治疗Lisfranc损伤并足骨筋膜室综合征的临床疗效.方法:回顾性分析2017年1月至2018年12月收治的5例Lisfranc损伤并足部骨筋膜室综合征患者的临床资料,其中男4例,女1例;年龄19～62岁.均为闭合性损伤.受伤至就诊时间1～14h.根据Myerson分型法,A型1例,B型...     

钉板系统结合空心钉治疗C型Lisfranc损伤的疗效探讨

目的：探讨运用微型钢板结合空心钉治疗C型Lisfranc损伤的临床疗效。方法回顾性分析2009年8月至2014年6月运用微型钢板结合空心钉治疗的25例C型Lisfranc损伤病人的临床资料,其中男16例,女9例;年龄为19~62岁,平均为（39.6±11.7）岁。运用微型钢板坚强固定内侧柱、中间柱,以空心钉替代损伤的Lisfranc韧带,外侧柱予克氏针弹性固定;术后随访时采用美国足踝外科医师协会（AOFAS）踝与后足功能评分系统评价治疗效果。结果所有病人均获随访,随访时间为6~36个月（平均为12.5个月）,术后正、侧位及斜位X线片示所有病例均达到解剖复位,未出现再次脱位,未见伤口感染、皮缘坏死等并发症。其中3例出现钢板断裂,予以取出内固定。参照AOFAS踝与后足功能评分系统,优16例,良5例,可4例,优良率为84.0%。结论运用微型钢板结合空心钉治疗C型Lisfranc损伤,符合足部生物力学,避免了单纯螺钉、克氏针固定引起的断钉无法取出、固定不稳定等不良后果,可以达到良好的解剖复位,术后可早期行功能锻炼。尽管存在一些并发症,但总体疗效满意。     

微型钛板跨关节固定结合埋头钉治疗Lisfranc损伤

目的 观察应用微型钛板结合埋头钉治疗Lisfranc损伤的临床疗效。 方法 回顾性分析我院自2016年8月至2018年7月收治的13例Lisfranc损伤患者资料。其中男9例,女4例,年龄35-69岁,平均49.2岁,受伤至手术时间为6-22天,平均为11.5天,所有患者经术前准备完善,局部软组织条件改善后行切开复位内固定术。采用美国足踝外科协会(AOFAS)中足功能评分及视觉模拟评分法(VAS)评估治疗效果,同时观察并发症情况。结果 所有患者获得随访,随访时间13个月到37个月,平均19.8个月。X线片显示术后3个月骨折端愈合,未出现再次脱位。末次随访时AOFAS评分为86.5±6.1,VAS评分为2.0±1.4,有1例患者出现伤口感染,1例患者取出内固定时发现有螺钉断裂。结论 微型钛板结合埋头钉治疗Lisfranc损伤固定效果可靠,有利于解剖复位,临床疗效满意。     

Outcome after open reduction and internal fixation of Lisfranc joint injuries

BACKGROUND: Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management. METHODS: We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. Among ninety-two adults treated for that injury, forty-eight patients with forty-eight injuries were followed for an average of fifty-two months (range, thirteen to 114 months). Fifteen injuries were purely ligamentous, and thirty-three were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score. RESULTS: The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 points, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six of them required arthrodesis. The major determinant of a good result was anatomical reduction (p = 0.05). The subgroup of patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation. CONCLUSIONS: Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores.     

后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折

目的:探讨后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折的临床疗效。方法:选取2013年5月至2016年6月行后外侧入路手术治疗踝部皮肤有损伤的Pilon骨折患者25例,其中男15例,女10例;年龄25~61(39.6±0.2)岁;采用后外侧为主的手术入路使用钢板固定,并辅助使用空心钉三维固定手术治疗。观察并记录踝部伤口及受伤时软组织挫擦伤愈合情况,采用Burwell-Charnley标准和美国足踝外科协会AOFAS踝-足评分系统进行功能评价。结果:25例患者获得随访,时间6~24个月,平均12个月。患者手术伤口及皮肤挤压擦伤均愈合。按照Burwell-Charnley标准,解剖复位22例,不满意2例,差1例。AOFAS踝-足评分为90.2±7.5,结果优20例,良3例,可2例。结论:后外侧入路钢板和拉力螺钉内固定治疗踝部皮肤损伤Pilon骨折可以完全避开前内侧损伤的皮肤及软组织,骨折固定牢固,有效地避免了软组织的进一步损伤坏死。     

Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study

BACKGROUND: Open reduction and internal fixation is currently the accepted treatment for displaced Lisfranc joint injuries. However, even with anatomic reduction and stable internal fixation, treatment of these injuries does not have uniformly excellent outcomes. The objective of this study was to compare primary arthrodesis with open reduction and internal fixation for the treatment of primarily ligamentous Lisfranc joint injuries. METHODS: Forty-one patients with an isolated acute or subacute primarily ligamentous Lisfranc joint injury were enrolled in a prospective, randomized clinical trial comparing primary arthrodesis with traditional open reduction and internal fixation. The patients were followed for an average of 42.5 months. Evaluation was performed with clinical examination, radiography, the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analog pain scale, and a clinical questionnaire. RESULTS: Twenty patients were treated with open reduction and screw fixation, and twenty-one patients were treated with primary arthrodesis of the medial two or three rays. Anatomic initial reduction was obtained in eighteen of the twenty patients in the open-reduction group and twenty of the twenty-one in the arthrodesis group. At two years postoperatively, the mean AOFAS Midfoot score was 68.6 points in the open-reduction group and 88 points in the arthrodesis group (p < 0.005). Five patients in the open-reduction group had persistent pain with the development of deformity or osteoarthrosis, and they were eventually treated with arthrodesis. The patients who had been treated with a primary arthrodesis estimated that their postoperative level of activities was 92% of their preinjury level, whereas the open-reduction group estimated that their postoperative level was only 65% of their preoperative level (p < 0.005). CONCLUSIONS: A primary stable arthrodesis of the medial two or three rays appears to have a better short and medium-term outcome than open reduction and internal fixation of ligamentous Lisfranc joint injuries.