钉板系统结合空心钉治疗C型Lisfranc损伤的疗效探讨

摘要

Objective To study the clinical effectiveness of internal fixation with mini⁃plates plus cannulated screws for treatment of type⁃C Lisfranc injury. Methods The clinical data of 25 cases (16 males and 19 females) of Lisfranc injury treated by internal fixation with mini⁃plates plus cannulated screws from August 2009 to June 2014 were retrospectively analyzed. The mean age of patients was 39.6 ± 11.7 years old (range 19⁃62 years). The medial and middle column were fixed with mini⁃plates, the lateral column was fixed with Kirschner wire, and Lisfranc ligament was replaced by the cannulated screw. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate the treatment outcome. Results All patients were followed up for 6⁃36 months (mean 12.5 months). The positive, lateral and oblique X⁃ray examina⁃tion showed that all cases achieved anatomical reduction, and no complications such as re⁃dislocation, wound infection, skin flap necrosis, etc. occurred. The mini⁃plate break occurred in 3 cases, and the internal fixators were removed. According to AOFAS score, there were excellent results in 16 cases, good in 5 cases, and fair in 4 cases, with an excellent and good rate of 84.0%. Conclusion We can offer an anatomic reduction and inter⁃nal fixation for the type⁃C Lisfranc fracture dislocation with mini⁃plates plus cannulated screws, the treat⁃ment accords with the foot biomechanics, and the adverse consequences such as broken nails caused by screw fixation, fixed instability were avoided. In spite of some complications, the overall effect is satisfactory.%目的：探讨运用微型钢板结合空心钉治疗C型Lisfranc损伤的临床疗效。方法回顾性分析2009年8月至2014年6月运用微型钢板结合空心钉治疗的25例C型Lisfranc损伤病人的临床资料，其中男16例，女9例；年龄为19~62岁，平均为（39.6±11.7）岁。运用微型钢板坚强固定内侧柱、中间柱，以空心钉替代损伤的Lisfranc韧带，外侧柱予克氏针弹性固定；术后随访时采用美国足踝外科医师协会（AOFAS）踝与后足功能评分系统评价治疗效果。结果所有病人均获随访，随访时间为6~36个月（平均为12.5个月），术后正、侧位及斜位X线片示所有病例均达到解剖复位，未出现再次脱位，未见伤口感染、皮缘坏死等并发症。其中3例出现钢板断裂，予以取出内固定。参照AOFAS踝与后足功能评分系统，优16例，良5例，可4例，优良率为84.0%。结论运用微型钢板结合空心钉治疗C型Lisfranc损伤，符合足部生物力学，避免了单纯螺钉、克氏针固定引起的断钉无法取出、固定不稳定等不良后果，可以达到良好的解剖复位，术后可早期行功能锻炼。尽管存在一些并发症，但总体疗效满意。