克氏针三柱重建法治疗Lisfranc骨折脱位

目的：探讨多根克氏针内固定治疗Lisfranc骨折脱位的，临床应用效果。方法：49例患者中，男37例，女12例；年龄20—58岁。损伤根据Myserson分型：A型12例；B1型3例，B2型28例；C1型4例，C2型2例。根据中足的结构特点设计多根克氏针进行三柱重建内固定，三柱的重建不仅需要每个独立柱的解剖复位和固定，且需要各柱相互形成一个联体。结果：49例均获随访，按美国骨科足踝外科协会（AOFAS）中足部分的评定标准，优（90-100分）14例，良（80-89分）22例，一般（70-79分）8例．差（60-69分）5例，平均（84、200±9．663）分。结论：Lisfrac骨折脱位的诊断和治疗应依从于三柱重建理论，使中足构成坚固的弓形结构，达到生物力学上的静态平衡．为骨折和软组织愈合提供环境。多根克氏针进行三柱重建内固定是治疗Lisfrac骨折脱位的有效方法。

Surgical treatment of Lisfranc fracture-dislocations by reconstruction of three-column with Kirschner wire fixation

Objective: To explore the effect of reduction and fixation with multi-Kirschner wires for treatment of Lisfranc fracture-dislocations. Methods: There were 49 patients(37 male and 12 female aged from 20 to 28 years old) involved in the study. According to the Myserson damage typing,type A in 12 cases,B1 in 3,B2 in 28,C1 in 4 and C2 in 2. Kirschner wires were applied to fix and reconstruct the three-column in three directions according to the structural characteristic of midfoot. Reconstruction of three-column needed not only to reduce and to fix every single column,but also to establish union of the columns. Results: According to the evaluation of AOFAS for midfoot,14 cases were excellent (90 to100),22 cases good(80 to 89),8 cases fair (70 to 79) and 5 cases poor (60 to 69),with an average score of 84.200±9.663. Conclusion: The diagnosis and treatment of Lisfranc fracture-dislocations should comply with the theory of three-column reconstruction of foot arch,which can achieve the static balance of biomechanics and provide a stable environment for healing of fracture and soft tissue. Reduction and fixation with multi-Kirschner wires is an effective treatment method for Lisfranc fracture-dislocations.