陈旧性Lisfranc损伤的成因与治疗

目的 分析陈旧性Lisfranc损伤的形成原因,探讨其手术治疗方法及效果. 方法2004年8月至2008年6月共收治20例陈旧性Lisfranc损伤患者,男16例,女4例;年龄21～49岁.术前均行CT三维重建,按照Myerson分型:Ⅰ型3例,Ⅱ型13例,Ⅲ型4例.17例患者行切开复位内固定,采用克氏针或螺钉固定,3例行关节融合术.术后按照Maryland足功能评分标准进行疗效评定. 结果 18例患者术后获6个月～4年(平均27个月)随访,2例失访.18例患者术后无内固定断裂、再骨折脱位等并发症发生.按照Maryland足功能评分标准评定疗效:66～96分,平均85分;其中优3例,良12例,可3例,优良率为83.3%.疗效欠佳的主要表现为中足疼痛、活动度减少. 结论影像学表现不典型、治疗不及时、方法选择有误等均可能造成陈旧性Lisfranc损伤.解剖复位、牢固内固定、重建足弓、恢复维持足部内外侧纵弓及横弓解剖形态是治疗的关键.

Diagnosis and treatment of old Lisfranc joint injury

Objective To discuss causes and treatment of old fracture dislocation of tarsometatarsal joints. Methods From August 2004 to June 2008, 20 cases (16 males and 4 females, 21 to 49 years old) of old Lisfranc injure were treated. According to Myerson classification, 3 cases were type Ⅰ, 13 cases type Ⅱ, and 4 cases type Ⅲ. X-ray emanation and three dimensional CT reconstruction were conducted. Open reduction and fixation using K-wires and screws were adopted for 17 cases and tarsometatarsal joints fusion for 3 cases. Results Postoperatively only 18 cases were followed up for 6 months to 4 years. According to Maryland scoring system, 3 cases were rated as excellent, 12 good, and 3 moderate. Although no breaking of internal fixator or refracture-dislocation was found, midfoot pain and limited walking function existed in some cases. Conclusions Lisfranc injuries are sometimes easily missed because of poor radiographic repre-sentations, or incorrect methods in primary diagnosis and treatment. For most old Lisfranc injury cases, open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results. And corrective arthrodesis can also release pain and lead to greater patient satisfaction. Anatomic reduction and stable fixation, especially anatomic restoration of the foot arch, are key points in the treatment of old Lisfranc injury.