CAJ | 학술논문

目的：观察闭合复位经皮内固定治疗Lisfranc损伤的中期临床效果。方法 Lisfranc损伤患者35例（37足）均闭合复位，采用经皮3．5 mm空心螺钉固定内侧、中柱，科氏针固定外侧柱。术后6、12、48个月随访。采用美国足踝外科学会（AOFAS）中足评分标准及视觉模拟量表（VAS）疼痛评分评价患者的临床效果，采用Paley－Hall评级标准评价Lisfranc关节的骨关节炎改变情况。结果患者骨折均愈合，随访中无患者出现螺钉断裂、拔出等内固定失败情况，均未出现感染以及皮肤相关的并发症问题。 AOFAS中足评分及VAS疼痛评分在术后6、12、48个月，均较术前显著改善（P＜0．05），但术后各时间点比较差异无统计学意义（P＞0．05）。术后平均3．5个月患者均基本恢复至正常活动水平。至末次随访时，8例（21．6％）出现继发退变性关节炎改变，均为Paley－Hall 1级。结论 Lisfranc损伤采用闭合复位经皮固定治疗的中期临床效果良好，创伤性关节炎的出现不会显著影响患者的临床效果。
목적：관찰폐합복위경피내고정치료Lisfranc손상적중기림상효과。방법 Lisfranc손상환자35례（37족）균폐합복위，채용경피3．5 mm공심라정고정내측、중주，과씨침고정외측주。술후6、12、48개월수방。채용미국족과외과학회（AOFAS）중족평분표준급시각모의량표（VAS）동통평분평개환자적림상효과，채용Paley－Hall평급표준평개Lisfranc관절적골관절염개변정황。결과환자골절균유합，수방중무환자출현라정단렬、발출등내고정실패정황，균미출현감염이급피부상관적병발증문제。 AOFAS중족평분급VAS동통평분재술후6、12、48개월，균교술전현저개선（P＜0．05），단술후각시간점비교차이무통계학의의（P＞0．05）。술후평균3．5개월환자균기본회복지정상활동수평。지말차수방시，8례（21．6％）출현계발퇴변성관절염개변，균위Paley－Hall 1급。결론 Lisfranc손상채용폐합복위경피고정치료적중기림상효과량호，창상성관절염적출현불회현저영향환자적림상효과。
Objective To observe the midterm results of Lisfranc′s joint injuries treated with closed reduction and percutaneous internal fixation .Methods Thirty-five patients ( 37 feet ) with Lisfranc′s joint injuries were given closed reduction .They received percutaneous fixation (3.5 mm cannulated screws ) of the joints of the medial and the middle column as well as fixation ( K-wires) of lateral column.All patients received the follow-up 6,12,48 months after surgery ,respectively .The results were evaluated using midfoot scale proposed by American Orthopedic Foot and Ankle Society(AOFAS) and visual analogue scale (VAS) pain scores.Paley and Hall scoring system was applied to assessing the osteoarthritic changes of Lisfranc′s joint.Results All patients gained their fractures healing .During the follow-up,there was no internal fixation failure of screw breakage or loss , no complications related with tissue and infection.AOFAS midfoot scores and VAS pain scores 6,12,48 months after surgery improved significantly compared with those before surgery(P<0.05),but for those scores at each time point ,the difference was not statistically significant (P>0.05).The average duration of the patients when their joints obtained the normal activity was 3.5 months.In the final follow-up,8 cases(21.6%) showed degenerative changes of secondary osteoarthritis ,which were Paley-Hall grade 1. Conclusion The therapy of closed reduction and percutaneous internal fixation has good effects on Lisfranc′s joint injuries.Posttraumatic osteoarthritis has a little negative impact on clinical results .