Nunley分型在低能量Lisfranc损伤治疗中的意义

目的探讨Nunley分型在治疗低能量Lisfranc损伤治疗中的临床价值。方法自2007年1月至2008年12月，24例低能量Lisfranc损伤的患者接受治疗。其中男性19例，女性5例。平均年龄37．7岁；左侧13例，右侧11例。扭伤7例，运动伤17例；开放性损伤3例，闭合性损伤21例；24例均为新鲜损伤。按Nunley标准分型，Ⅰ型损伤5例，Ⅱ型损伤11例，Ⅲ型损伤8例，其中合并舟骨骨折1例，骰骨骨折3例，楔骨骨折8例，跖骨骨折13例。7例行石膏固定等保守治疗，1例行闭合复位经皮克氏针内固定，16例行切开复位内固定治疗。内固定材料包括空心螺钉、克氏针及低模量微型钢板。结果23例得以随访，平均随访33．8个月（18～54个月），根据美国足踝外科协会（American orthopaedic foot and ankle society score，AOFAS）中足评分标准评估疗效，优13例（56．5％），良7例（30．4％），可1例（4．3％），差2例（8．7％），总体优良率为87．0％。结论Nunley分型标准对治疗低能量Lisfranc损伤有重要的临床指导意义。术前准确诊断，术中做到解剖复位并选择合适的内固定物，维持力线的长度和足纵弓的正常形态，便可获得满意的效果。对于有争议的Ⅱ型损伤，手术治疗效果优于保守治疗。

Clinical Value of Nunley Classification in the Treatment for Low Energy Lisfranc Injury

Objeetive To discuss the clinical value of Nunley Classification in the treatment for low energy Lisfranc injury. Methods From January,2007 to December,2008,24 patients of low energy Lisfranc injury have undergone therapies. There were 19 male and 5 female cases 24 with an average age of 37.7. There were left side of injuries in 13 eases,the right side in 11 cases ,sprain in 7 cases ,sports injuries in 17eases. All 24 cases were recent in injuries. In accordance with Nunley Standard Classification,5 cases were classified into Type I, 11 cases Type Ⅱ ,and 8 cases type Ⅲ. Moreover,one of all cases had a complication with seaphoid fracture, 3 cases with cuboid fracture, 8 cases with cuneiform fracture and 13 cases with metatarsus fracture. 7 cases had received conservative therapies as plaster fixations,one case had been applied with closed reduction with pereutaneous Kirschner internal fixation and 16 cases had received open reductions with internal fixations. The instruments for internal fixations include hollowed screwed nail,Kirschner and Low modulus micro-plate. Results 23 cases had been followed up for an average of 33.8 months, ranging from 18 to 54 months. According to the assessment of efficacy for Foot by AOFAS, 13 cases ere classified to excellence level by taking a percentage of 56.5,7 cases to good level by 30.4%,1 case to approval level by 4.30% and 2 eases to failed level by 4.3%. Conclusion Nunley Standard Classification has a important clinical guidance in the therapy for low energy Lisfranc injury. It will present a satisfying result to acquire an accurate pre-operative diagno- sis,reach intra-operative anatomical reduction with suitable internal fixation to maintain the length of force and mor phology of vertical foot arch. As for those argumentative cases of Type I injuries ,the operative therapies show a bet ter efficacy than the conservative treatments.