不同方式手术治疗足部Lisfranc骨折脱位疗效比较

Comparison of the effect of different surgical methods on Lisfranc injury

关键词:  Lisfranc损伤  切开复位内固定  微型钢板  螺钉

Key words:  Lisfranc injury  open reduction and internal fixation  mini plate  screw

摘要:

目的 比较两种不同方式手术治疗足部Lisfranc骨折脱位的中短期疗效。方法 选取2012年9月至2015年3月间内侧柱与中间柱损伤的Lisfranc骨折脱位，均接受手术治疗的患者24例。根据使用的内固定物不同分为两组：螺钉固定组（螺钉组，12例）和跨关节钢板固定组（钢板组，12例）。比较两组的手术时间，软组织愈合情况，术后6个月及取出内固定物后3个月的美国足踝外科协会（AOFAS）评分和疼痛视觉模拟评分（VAS），评价治疗效果。结果 术后螺钉组软组织均愈合良好，钢板组有1例切口局部皮肤坏死；螺钉组及钢板组的手术时间分别为（52.04±16.03）min和（72.58±22.83）min，差异具有显著性意义（P<0.05）；术后6个月，螺钉组与钢板组的AOFAS评分分别为（76.83±4.60）和（65.46±6.80），差异具有显著性意义（P<0.05），VAS评分分别为（2.74±0.43）和（3.03±0.55），差异无显著性意义（P>0.05）；取出内固定后3个月，螺钉组和钢板组的AOFAS评分及VAS评分均无显著性差异（P>0.05）。结论 螺钉及钢板固定足部Lisfranc骨折脱位均可获得良好效果，螺钉组的手术时间相对较短，并发症更少。

Abstract:

Objective To compare the short and medium-term results of two different surgical methods for Lisfranc fracture and dislocation of foot. Methods From September 2012 to March 2015, 24 patients with Lisfranc fracture and dislocation with medial and intermediate column injuries were retrospectively analyzed. According to the different internal fixators used, they were divided into two groups:(1) screw fixation group and (2) plate fixation group, 12 cases in each group. The operation time, soft tissue healing, the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS) at 6 months after operation and 3 months after removal of internal fixation were compared between the two groups. Results All patients were followed up. In screw group, the soft tissue healed well; while in plate group, there was 1 case of local skin necrosis. The operation time of screw group and plate group were (52.04±16.03) minutes and (72.58±22.83) minutes, respectively, the difference was significant (P<0.05). The AOFAS scores at 6 months after operation of screw group and plate group were (76.83±4.60) and (65.46±6.80) respectively, with significant difference (P<0.05). The VAS of screw group and plate group were (2.74±0.43) and (3.03±0.55) respectively, with no significant difference (P>0.05). There were no significant difference on AOFAS and VAS scores between screw group and plate group at 3 months after removing the implant (P>0.05). Conclusion Screw and plate fixation of Lisfranc fractures and dislocations of the foot can obtain good results. The operation time of screw group is relatively short with less complications.