切开复位内固定治疗早期Lisfranc关节损伤

目的 总结分析切开复位内固定治疗早期Lisfranc关节损伤的临床经验.方法 2005-2010年共收治Lisfranc关节损伤12例,男10例,女2例;平均年龄34岁(8-60岁).Myerson分型:A型2例,B型8例,C型2例.所有患者均在伤后17 d内接受手术,手术采用切开复位、螺钉或克氏针内固定.术后采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)中足评分标准进行功能评估;术前、术后采用X线摄片(正、侧及左右斜位)和CT扫描进行影像学评估.结果 所有患者均获得有效随访,平均随访33个月(6-60个月).术后AOFAS中足评分平均74.5分(53～96分),其中优8例,良2例,中2例.X线片和CT扫描示8例获得解剖复位.所有患者均骨性愈合.本组未见任何手术并发症.结论 切开复位内固定是治疗早期Lisiranc关节损伤的有效方法,术前应结合临床、X线片和CT扫描进行综合分析.

Abstract：

Objective To summarize the clinical experience in treatment of the Lisfranc joint injury with open reduction and internal fixation at early stage. Methods Twelve patients ( including ten males and two females at average age of 34 years) with early stage Lisfranc joint injury received open reduction and screw/wire fixation from 2005 to 2010. According to the Myerson classification, there were two patients with type A, eight with type B and two with type C. All the patients received open reduction and internal fixation with screw or Kirschner wire within 17 days after injury. The post-operative function was estimated by mid-foot scoring scale of AOFAS. X-ray and CT scan were used in radiography estimation. Results All the patients were followed up for average 33 months ( range, 6-60 months). The mean score of post-operative mid-foot scoring scale of AOFAS was 74.5 points ( range, 53-96 points), with excellent result in eight patients, good in two and fair in two. The anatomical reduction was observed in eight patients and all the patients obtained bony union according to the results of X-ray and CT scan.There was no any complication found.Conclusions Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury at early stage. A preoperative comprehensive analysis combined with clinical X-ray and CT scan is necessary.     

门型钢板后路固定治疗C3型骨盆骨折疗效分析

目的探讨后路重建门型钢板内固定治疗C3型骨盆骨折的疗效及优势。方法我院自2007年3月至2009年9月起对31例C3型骨盆骨折患者,行门型钢板后路固定治疗。结果本组病例中有4例伤后3～4个月陈旧性骨折病例,复位困难,仅行后路门型钢板原位固定;1例患者过早负重,发生螺钉断裂;其余病例复位、固定均满意,骨盆环稳定,随访1～2年,负重行走功能良好,疗效满意。结论门型钢板后路固定手术是治疗C3型骨盆骨折、恢复骨盆环稳定及后方结构连续性的简单、有效、可靠的方法。