CAJ | 학술논문

目的探讨桥接钢板关节融合术治疗陈旧性Lisfranc损伤的手术技巧和疗效. 方法回顾性分析2008年1月至2010年8月收治的26例(26足)陈旧性Lisfranc损伤患者资料,男18例,女8例;年龄18 ～ 65岁,平均34.6岁.26例患者均采用桥接钢板内固定行跖跗关节融合术.受伤至手术时间为6～13个月,平均8.9个月.术前摄负重位X线片和CT片,制定个体化融合方案.记录损伤愈合时间及相关并发症,并比较术前与末次随访时美国骨科足踝外科协会(AOFAS)中足评分、疼痛视觉模拟评分(VAS)及SF-36健康调查简表评分.结果 19例患者术后获12 ～ 30个月(平均16.4个月)随访,7例失访.患者切口均一期愈合,无感染等软组织并发症发生.术后X线片示融合处愈合时间平均为12个月.末次随访时19例患者AOFAS中足评分由术前平均(49.6±15.4)分上升至(76.8±11.5)分,VAS评分由术前平均(5.7±3.2)分降低至(1.4±0.8)分,SF-36健康调查简表评分由术前平均(38.7±7.4)分改善至(74.0±6.4)分,差异均有统计学意义(P＜0.05).2例患者出现舟楔关节炎,伴中度以上疼痛及行走受限,二期予舟楔关节融合术后愈合.未见内固定失效、融合失败、融合处畸形愈合等相关并发症发生. 结论解剖重建中足力线及桥接钢板固定融合跖跗关节是治疗陈旧性Lisfranc损伤安全、有效的方法.
목적 탐토교접강판관절융합술치료진구성Lisfranc손상적수술기교화료효. 방법 회고성분석2008년1월지2010년8월수치적26례(26족)진구성Lisfranc손상환자자료,남18례,녀8례;년령18 ～ 65세,평균34.6세.26례환자균채용교접강판내고정행척부관절융합술.수상지수술시간위6～13개월,평균8.9개월.술전섭부중위X선편화CT편,제정개체화융합방안.기록손상유합시간급상관병발증,병비교술전여말차수방시미국골과족과외과협회(AOFAS)중족평분、동통시각모의평분(VAS)급SF-36건강조사간표평분.결과 19례환자술후획12 ～ 30개월(평균16.4개월)수방,7례실방.환자절구균일기유합,무감염등연조직병발증발생.술후X선편시융합처유합시간평균위12개월.말차수방시19례환자AOFAS중족평분유술전평균(49.6±15.4)분상승지(76.8±11.5)분,VAS평분유술전평균(5.7±3.2)분강저지(1.4±0.8)분,SF-36건강조사간표평분유술전평균(38.7±7.4)분개선지(74.0±6.4)분,차이균유통계학의의(P＜0.05).2례환자출현주설관절염,반중도이상동통급행주수한,이기여주설관절융합술후유합.미견내고정실효、융합실패、융합처기형유합등상관병발증발생. 결론 해부중건중족력선급교접강판고정융합척부관절시치료진구성Lisfranc손상안전、유효적방법.
Objective To evaluate the surgical techniques and clinical outcomes of tarsometatarsal arthrodesis with a bridging plate in the treatment of Lisfranc malunion.Methods From January 2008 to August 2010,26 patients with Lisfranc malunion (26 feet) were treated by tarsometatarsal arthrodesis with a bridging plate in our department.They were 18 males and 8 females with an average age of 34.6 years (from 18 to 65 years).The duration from injury to operation ranged from 6 to 13 months (average,8.9 months).Thorough radiographic examinations including weight-bearing X-ray and 3-D reconstruction CT scan were carried out before surgery so as to formulate an individualized surgical protocol.X-rays were taken during follow-ups to confirm the bone healing.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores,visual analogue scale (VAS) and The Short Form-36 (SF-36) scores before operation and at the last follow-up were recorded and compared.Results Nineteen patients obtained a mean follow-up of 16.4 months (from 12 to 30 months).The other 7 were lost to the follow-up.All the wounds healed at the first stage without soft tissue complications.The postoperative X-ray showed that the fusion healed after an average of 12 months.At the last follow-up,their AOFAS score increased significantly from preoperative 49.6 ± 15.4 points to postoperative 76.8 ± 11.5 points,their VAS score decreased significantly from preoperative 5.7 ± 3.2 points to postoperative 1.4 ±0.8 points,and their SF-36 score increased significantly from preoperative 38.7 ± 7.4 points to postoperative 74.0 ± 6.4 points (P ＜ 0.05).Talonavicular arthritis occurred in 2 patients who had moderate to severe pain and limitation of walking which were cured by talonavicular arthrodesis.No implant failure,fusion failure or malunion occurred.Conclusion Anatomical reconstruction of the midfoot alignment followed by tarsometatarsal arthrodesis with a bridging plate is an effective and reliable treatment of Lisfranc malunion.