闭合复位经皮空心钉结合克氏针内固定治疗Lisfranc损伤

摘要

Objective To analyze the clinical effect of close reduction and internal fixation with percutaneous cannulated screws and Kirschner wire for Lisfranc injury.Methods From September,2010 to March,2015,37 patients with Lisfranc joint injury,29 male and 8 female and 17-62 years (average 36.5) old,were treated with close reduction and internal fixation with percutaneous cannulated screws and Kirschner wire.According to the Myerson classification,11 cases were type A,11 type B 1,8 type B2,5 type C 1,and 2 type C2.The postoperative function was estimated by American Orthopaedic Foot and Ankle Society (AOFAS) anklehindfoot score and pain visual analogue scale (VAS).Results All the patients were followed up 6 to 18 months (averaged 12.7 months).According to AOFAS foot score,20 got excellent results,14 good,2 medium,and 1 fair.The rate of good and excellent results was 91.89％.The VAS score decreased from (7.3±1.1) before the operation to (1.2±0.8) after the operation.All differences were statistically significant (P＜0.05).Conclusions Close reduction and internal fixation with percutaneous cannulated screws and Kirschner wire for Lisfranc joint injury is effective.The reduction of the middle column with screw insertion along the direction of Lisfranc ligament is the key for the reestablishment of the stability of Lisfranc joint.%目的 分析采用闭合复位经皮内固定治疗Lisfranc损伤的临床疗效.方法 自2010年9月至2015年3月,共治疗Lisfranc关节损伤37例,男女比例为29∶8;年龄17～62岁,平均36.5岁.Myerson分型:A型11例,B1型ll例,B2型8例,C1型5例,C2型2例.手术均采用闭合复位经皮空心钉结合克氏针内固定.术后应用美国足踝协会(AOFAS)踝-后足评分和疼痛视觉模拟评分(VAS)进行评定.结果 所有患者均获得随访,随访时间为6～ 18月(平均12.7月).根据AOFAS踝-后足评分:优20例,良14例,中2例,差l例,优良率为91.89％.VAS由术前(7.3±1.1)分降至(1.2±0.8)分.差异均有统计学意义(P＜0.05).结论 闭合复位经皮空心钉结合克氏针内固定是治疗Lisfranc关节损伤的有效方法,中间柱复位并沿Lisfranc韧带方向置人螺钉内固定是重建Lisfranc关节稳定性的关键.