[1]张新,李雨果,卓乃强△.锁定加压钢板联合空心钉及克氏针治疗跖跗关节损伤39例[J].中国中医骨伤科杂志,2023,31(03):72-77.[doi:10.20085/j.cnki.issn1005-0205.230314]
　ZHANG Xin,LI Yuguo,ZHUO Naiqiang.39 Cases of Clinical Report on Locking Compression Plate Combined with Cannulated Screw and Kirschner Wire on the Treatment of Lisfranc Injury[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(03):72-77.[doi:10.20085/j.cnki.issn1005-0205.230314]
点击复制

锁定加压钢板联合空心钉及克氏针治疗跖跗关节损伤39例()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年03期
页码:
72-77
栏目:
临床报道
出版日期:
2023-03-15

文章信息/Info

Title:
39 Cases of Clinical Report on Locking Compression Plate Combined with Cannulated Screw and Kirschner Wire on the Treatment of Lisfranc Injury
文章编号:
1005-0205(2023)03-0072-06
作者:
张新1; 李雨果1; 卓乃强1△
1西南医科大学附属医院骨与关节外科(四川 泸州,646000)
Author(s):
ZHANG Xin1; LI Yuguo1; ZHUO Naiqiang1△
1Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan China.
关键词:
跖跗关节损伤;  锁定加压钢板;  空心钉;  内固定;  中足
Keywords:
Lisfranc injury;  locking compression plate;  cannulated screw;  internal fixation;  midfoot
分类号:
R684
DOI:
10.20085/j.cnki.issn1005-0205.230314
文献标志码:
B
摘要:
目的:评估锁定加压钢板(LCP)联合空心钉及克氏针治疗跖跗关节损伤(Lisfranc损伤)的临床疗效。方法:选取2016年6月至2020年5月收治的跖跗关节损伤患者39例,采用锁定加压钢板联合空心钉及克氏针内固定治疗。术后定期影像学检查并观察并发症情况,末次随访时依据美国足踝关节协会(AOFAS)评分系统对患足功能进行评估。结果:所有纳入患者均获得完整随访,随访时间为15～18个月,平均为17.2个月。根据Myerson分型:A型17足,B型12足,C型10足。所有患者均未发生内固定物松动或断裂、骨折再次移位、骨折不愈合、伤口感染、皮缘坏死、慢性骨髓炎等并发症,均为一期愈合。末次随访时,患足功能评定为“可”的患者中1例出现足弓塌陷,诊断为扁平足; 2例跖跗关节疼痛,诊断为创伤性骨关节炎,需口服非甾体类抗炎药物(NSAID)止痛。术后15个月依据美国足踝关节协会中足评分标准对39例患者患足的功能进行评定,AOFAS评分(90～100分为优,80～89分为良,70～79分为可,<70分为差)结果:优30例,良6例,可3例,差0例,患足功能恢复优良率为92.31%。结论:通过锁定加压钢板联合空心钉及克氏针治疗跖跗关节损伤达到解剖复位,钢板及螺钉放置简便,固定可靠,临床疗效显著。
Abstract:
Objective:To appraise the clinical efficacy of locking compression plate(LCP)combined with cannulated screw on the treatment of Lisfranc injury. Methods:Thirty-nine cases of Lisfranc injury treated from June 2016 to May 2020 were selected and treated with locking compression plate combined with cannulated screw internal fixation. Postoperative imaging examinations were performed regularly and complications were observed. At the last follow-up, the function of the affected foot was evaluated according to the American Orthopedic Foot and Ankle Society(AOFAS)scoring system. Results:All patients were followed up for 15 to 18 months, with an average of 17.2 months. According to Myerson, type A has 17 feet, type B has 12 feet and Type C has 10 feet. No complications such as internal fixation loosening or fracture, fracture redisplacement, fracture nonunion, wound infection, cutaneous necrosis, and chronic osteomyelitis occurred in all patients, all of which were primary healing. At the last follow-up, among the patients with “OK” foot function, 1 case had arch collapse and was diagnosed as flat foot, and 2 cases had tarsal joint pain and was diagnosed as traumatic osteoarthritis, requiring oral nonsteroidal antiinflammatory drugs(NSAID)for pain relief. The function of the affected feet of 39 patients was evaluated 15 months after surgery according to the AOFAS medium foot scale. AOFAS score: 90 to 100 is excellent, 80 to 89 is good, 70 to 79 is fair, <70 is poor. Among them, 30 cases were excellent, 6 cases were good, 3 cases were fair, and 0 case was bad. The excellent and good rate of functional recovery of affected foot was 92.31%. Conclusion:The treatment of Lisfranc injury by locking compression plate combined with cannulated screw had good reduction, easy placement of plate and screw, reliable fixation, and significant clinical efficacy.

参考文献/References:

[1] HAAPAMAKI V V,KIURU M J,KOSKINEN S K.Ankle and foot injuries:analysis of MDCT findings[J].Am J Roentgenol,2004,183(3):615-622.
[2] REINHARDT K R,OH L S,SCHOTTEL P,et al.Treatment of Lisfranc fracture-dislocations with primary partial arthrodesis[J].Foot Ankle Int,2012,33(1):50-56.
[3] ABBASIAN M R,PARADIES F,WEBER M,et al.Temporary internal fixation for ligamentous and osseous Lisfranc injuries:outcome and technical tip[J].Foot Ankle Int,2015,36(8):976-983.
[4] 李雪松,邸薇宁,李景银,等.微型锁定加压钢板结合拉力螺钉及克氏针治疗A型Lisfranc损伤27例[J].中国中医骨伤科杂志,2017,25(6):68-70.
[5] KITAOKA H,ALEXANDER I,ADELAAR R,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux and lesser toes[J].Foot Ankle Clin,1994,15(7):349-353.
[6] GAWEDA K,TARCZYNSKA M,MODRZEWSKI K,et al.An analysis of pathomorphic forms and diagnostic difficulties in tarsometatarsal joint injuries[J].Int Orthop,2008,32(5):705-710.
[7] WELCK M J,ZINCHENKO R,RUDGE B.Lisfranc injuries[J].Injury,2015,46(4):536-541.
[8] 郗艳,胡丁君,姚伟武,等.跖跗关节损伤的分型及影像学诊断[J].中华医学杂志,2016,96(25):1976-1981.
[9] DEORIO M,ERICKSON M,USUELLI F G,et al.Lisfranc injuries in sport[J].Foot Ankle Clin,2009,14(2):169-186.
[10] HALAI M,JAMAL B,REA P,et al.Acute fractures of the pediatric foot and ankle[J].World J Pediatr,2015,11(1):14-20.
[11] MYERSON M S,FISHER R T,BURGESS A R,et al.Fracture dislocations of the tarsometatarsal joints:end results correlated with pathology and treatment[J].Foot Ankle,1986,6(5):225-242.
[12] NUNLEY J A,VERTULLO C J.Classification,investigation,and management of midfoot sprains:Lisfranc injuries in the athlete[J].Am J Sports Med,2002,30(6):871-878.
[13] CRATES J M,BARBER F A,SANDERS E J,et al.Subtle Lisfranc subluxation:results of operative and nonoperative treatment[J].J Foot Ankle Surg,2015,54(3):350-355.
[14] LAU S,MBB S,HOWELLS N,et al.Plates,screws,or combination? Radiologic outcomes after Lisfranc fracture dislocation[J].Foot Ankle Surg,2016,55(4):799-802.
[15] LI B,ZHAO W,LEI L,et al.Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury[J].Chinese Journal of Traumatology,2015,18(1):18-20.
[16] 邓宇.Lisfranc关节损伤的诊治进展[J].临床医药文献杂志,2018,5(33):194-196.
[17] 魏新锁,文凯,袁泉,等.切开复位内固定治疗Lisfranc关节损伤21例[J].河南外科学杂志,2010,16(1):28-30.
[18] 胡军,丘锦泉,黄德东,等.空心螺钉与微型钢板治疗Lisfranc损伤的疗效分析[J].实用手外科杂志,2021,35(2):230-232.
[19] 刘璠.正确掌握锁定钢板的理念及技术[J].中华创伤骨科杂志,2011,13(3):201-202.
[20] SMITH N,STONE C,FUREY A.Does open reduction and internal fixation versus primary arthrodesis improve patient outcomes for Lisfranc trauma? A systematic review and meta-analysis[J].Clin Orthop Relat Res,2015,474(6):1-8.
[21] 陈宇,张晖,刘熹,等.切开复位联合万向锁定钢板治疗急性Lisfranc骨折脱位[J].中华创伤骨科杂志,2019,21(4):314-320.
[22] 芦浩,徐海林,党育,等.Suture-Button技术治疗急性Lisfranc损伤[J].中华创伤骨科杂志,2019,21(4):310-313.
[23] 徐世明,孙大炜,黄东,等.Lisfranc损伤的诊断和治疗研究进展[J].山东医药,2018,58(7):111-114.
[24] 王晓康,顾文奇,蒋剑涛,等.选择性跖跗关节融合术治疗陈旧性Lisfranc损伤[J].中华医学杂志,2019,99(21):1626-1630.

备注/Memo

备注/Memo:
△通信作者 E-mail:znq0101@163.com
更新日期/Last Update: 2023-03-10