伴骰骨压缩性骨折的Lisfranc损伤的切开复位内固定（开放获取）

Open reduction and internal fixation of Lisfranc injury complicated with cuboid compression fractures

摘要:

[目的] 评价切开复位微型锁定钛板内固定治疗伴有骰骨压缩性骨折的Lisfranc 损伤的临床疗效。[方法] 回顾性分析2015 年10 月—2018 年1 月作者医院采用切开复位微型锁定钛板内固定伴有骰骨压缩性骨折的Lisfranc 损伤21 例患者的临床资料，其中男13 例，女8 例。评估临床和影像资料。[结果] 所有患者均顺利手术，术中无血管神经损伤，平均随访（29.3±8.9） 个月。随访过程中，1 例患者因行走时中足部位疼痛明显行二次跖跗关节融合手术。与术前相比，末次随访时VAS评分[(5.3±0.6), (1.2±0.9), P＜0.001] 和AOFAS 踝-后足评分[(50.1±3.4), (83.0±6.3), P＜0.001] 均显著改善。末次随访时，临床结果评定为优3 例，良14 例，可4 例，差0 例，优良率94.4%。影像方面，与术前相比，末次随访时台阶征位移距离（step-offsign, SOS） [(4.7±1.2) mm, (1.3±0.5) mm, P＜0.001]、M1-M2 间隙[(13.4±1.9) mm, (2.3±0.6) mm, P＜0.001]、C1-C2 间隙[(3.1±1.4) mm,(1.7±0.5) mm, P＜0.001] 和Meary 角[(18.8±8.9)°, (2.8±0.9)°, P＜0.001] 均显著改善。至末次随访时2 例患者外侧柱遗留轻度短缩畸形，11 例患者有不同程度的跖跗关节炎征象。[结论] 切开复位微型锁定钛板内固定治疗伴骰骨压缩性骨折的Lisfranc 损伤，可有效恢复外侧柱长度，避免继发足部畸形的发生，临床效果满意。

Abstract:

[Objective] To evaluate the clinical efficacy of open reduction and internal fixation (ORIF) with mini locked titanium platefor Lisfranc injury complicated with cuboid compression fractures. [Methods] A retrospective study was performed on 21 patients who re-ceived ORIF for Lisfranc injury complicated with cuboid compression fractures in our hospital from October 2015 to January 2018, includ-ing 13 males and 8 females. The clinical and imaging data were evaluated. [Results] All patients had ORIF conducted successfully withoutvascular and nerve injury, and followed up for a mean of (29.3±8.9) months. During the follow-up, 1 patient of them underwent revision tar-sometatarsal fusion due to significant pain in the middle foot during walking. Compared with those preoperatively, the VAS scores [(5.3±0.6), (1.2±0.9), P＜0.001] and AOFAS ankle-hindfoot score [(50.1±3.4), (83.0±6.3), P＜0.001] were significantly improved at th last followup.The clinical outcome were marked as excellent in 3 cases, good in 14 cases, fair in 4 cases poor in 0 case by the time of latest followup,with excellent and good rate of 94.4%. As for imaging, the step-off sign (SOS) [(4.7±1.2) mm, (1.3±0.5) mm, P＜0.001], M1-M2 distance[(13.4±1.9) mm, (2.3±0.6) mm, P＜0.001], C1-C2 distance [(3.1±1.4) mm, (1.7±0.5) mm, P＜0.001], and Meary's angle [(18.8±8.9)°, (2.8±0.9)°, P＜0.001] were significantly improved at the last follow-up compared with those preoperatively. Up to the last follow-up, 2 patientshad mild lateral column shortening deformity and 11 patients had signs of metatarsal arthritis in varying extent. [Conclusion] ORIF withmini locking titanium plate for Lisfranc injury complicated with cuboid bone compression fractures do effectively restore the length of thelateral column and avoid the occurrence of secondary foot deformities, and achieve satisfactory clinical consequence.