無頭加壓空心螺釘治療Lisfranc損傷的臨床及影像學療效評估_《中國修復重建外科雜志》

作者：

張暉 , 閔理 , 王光林 , 劉雷 , 方躍 , 屠重棋

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

Lisfranc損傷無頭加壓空心螺釘內固定

DOI：

10.7507/1002-1892.20130262

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目的探討無頭加壓空心螺釘內固定治療Lisfranc損傷的臨床及影像學療效及其影響因素。方法回顧性分析2006年1月－2012年1月，采用無頭加壓空心螺釘治療并獲隨訪1年以上的34例36足Lisfranc損傷患者臨床資料。男22例24足，女12例12足；年齡21～73歲，平均38.9歲。致傷原因：交通事故傷16例17足，高處墜落傷11例12足，碾壓傷5例5足，運動損傷2例2足。19例20足為閉合性損傷，15例16足為開放性損傷。單純Lisfranc關節脫位及韌帶性損傷（pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries，LD）7 例8足，Lisfranc關節骨折脫位（Lisfranc joint fracture dislocations，LFD）22例23足，合并Chopart關節損傷的LFD（combined Chopart-LFD，CLFD）5例5足。根據Myerson等分類系統：A型5例5足，B1型7例8足，B2型14例15足，C1型5 例5足，C2型3例3足。合并跖骨干骨折12例13足，骰骨骨折4例4足，舟骨骨折4例4足，楔骨骨折/脫位6例7足，同側下肢多處骨折8例10足，對側下肢多處骨折4例4足。臨床療效采用美國矯形足踝協會（AOFAS）評分標準，足部疼痛評價采用疼痛視覺模擬評分（VAS）評價。根據雙足正、側位及45°斜位X線片，觀察Lisfranc關節解剖復位，螺釘斷裂、創傷性關節炎以及足弓恢復等情況。結果患者均獲隨訪，隨訪時間1年～5年2個月，平均3.5年。X線片示，31例33足（91.7%）獲解剖復位。末次隨訪時，VAS評分為0～6分，平均2.3分；AOFAS評分為60～100分，平均80.6分，其中解剖復位患者評分顯著高于非解剖復位患者，LD、LFD患者評分顯著高于CLFD患者，合并楔骨骨折/脫位患者評分顯著低于未合并楔骨骨折/脫位患者，比較差異均有統計學意義（P lt; 0.05）。末次隨訪時患側距骨-第1跖骨角、第1、2跖骨基部間距、足弓高度與健側比較，差異均無統計學意義（P gt; 0.05）。1例1足因過早負重導致復位丟失；9例10足并發創傷性關節炎。創傷性關節炎及非創傷性關節炎患者中解剖復位、合并楔骨骨折/脫位、嚴重關節內粉碎性骨折、損傷模式構成差異均有統計學意義（P lt; 0.05）。結論采用無頭加壓空心螺釘治療Lisfranc損傷患者可獲得良好療效。但應注意術中解剖復位，穩定固定，尤其對于合并Chopart關節損傷、楔骨骨折/脫位、嚴重關節內粉碎性骨折患者，應盡量避免繼發性創傷性關節炎的發生。

引用本文： 張暉,閔理,王光林,劉雷,方躍,屠重棋. 無頭加壓空心螺釘治療Lisfranc損傷的臨床及影像學療效評估. 中國修復重建外科雜志, 2013, 27(10): 1196-1201. doi: 10.7507/1002-1892.20130262 復制

1.	Hardcastle PH, Reschauer R, Kutscha-Lissberg E, et al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg (Br), 1982, 64(3): 349-356.
2.	Teng AL, Pinzur MS, Lomasney L, et al. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int, 2002, 23(10): 922-926.
3.	Chiodo CP, Myerson MS. Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am, 2001, 32(1): 11-20.
4.	Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg (Am), 2000, 82-A(11): 1609-1618.
5.	Pereira CJ, Espinosa EG, Miranda I, et al. Evaluation of the surgical treatment of Lisfranc joint fracture-dislocation. Acta Ortop Bras, 2008, 16: 93-97.
6.	Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg (Br), 2008, 90(11): 1499-1506.
7.	Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg (Am), 2006, 88(3): 514-520.
8.	Richter M, Thermann H, Hüfner T, et al. Aetiology, treatment and outcome in Lisfranc joint dislocations and fracture dislocations. Foot Ankle Surg, 2002, 8(1): 21-32.
9.	Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
10.	Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
11.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12.	Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg (Am), 1990, 72(10): 1519-1522.
13.	Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35(Suppl 2): SB71-76.
14.	Lee CA, Birkedal JP, Dickerson EA, et al. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int, 2004, 25(5): 365-370.
15.	Thordarson DB. Lisfranc ORIF with absorbable fixation. Techniques in Foot and Ankle Surgery, 2003, 2(1): 21-26.
16.	Borazjani BH, Chen AC, Bae WC, et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg (Am), 2006, 88(9): 1934-1943.
17.	Augustin G, Davila S, Udiljak T, et al. Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report. Arch Orthop Trauma Surg, 2008, 129(5): 703-709.
18.	Augustin G, Davila S, Mihoci K, et al. Thermal osteonecrosis and bone drilling parameters revisited. Arch Orthop Trauma Surg, 2008, 128(1): 71-77.
19.	Cosculluela PE, Ebert AM, Varner KE. Dorsomedial bridge plating of Lisfranc injuries. Techniques in Foot and Ankle Surgery, 2009, 8(4): 215-220.
20.	Cottom JM, Hyer CF, Berlet GC. Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases. J Foot Ankle Surg, 2008, 47(3): 250-258.
21.	Panchbhavi VK, Vallurupalli S, Yang J, et al. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg (Am), 2009, 91(5): 1143-1148.

1. Hardcastle PH, Reschauer R, Kutscha-Lissberg E, et al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg (Br), 1982, 64(3): 349-356.
2. Teng AL, Pinzur MS, Lomasney L, et al. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int, 2002, 23(10): 922-926.
3. Chiodo CP, Myerson MS. Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am, 2001, 32(1): 11-20.
4. Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg (Am), 2000, 82-A(11): 1609-1618.
5. Pereira CJ, Espinosa EG, Miranda I, et al. Evaluation of the surgical treatment of Lisfranc joint fracture-dislocation. Acta Ortop Bras, 2008, 16: 93-97.
6. Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg (Br), 2008, 90(11): 1499-1506.
7. Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg (Am), 2006, 88(3): 514-520.
8. Richter M, Thermann H, Hüfner T, et al. Aetiology, treatment and outcome in Lisfranc joint dislocations and fracture dislocations. Foot Ankle Surg, 2002, 8(1): 21-32.
9. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
10. Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12. Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg (Am), 1990, 72(10): 1519-1522.
13. Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35(Suppl 2): SB71-76.
14. Lee CA, Birkedal JP, Dickerson EA, et al. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int, 2004, 25(5): 365-370.
15. Thordarson DB. Lisfranc ORIF with absorbable fixation. Techniques in Foot and Ankle Surgery, 2003, 2(1): 21-26.
16. Borazjani BH, Chen AC, Bae WC, et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg (Am), 2006, 88(9): 1934-1943.
17. Augustin G, Davila S, Udiljak T, et al. Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report. Arch Orthop Trauma Surg, 2008, 129(5): 703-709.
18. Augustin G, Davila S, Mihoci K, et al. Thermal osteonecrosis and bone drilling parameters revisited. Arch Orthop Trauma Surg, 2008, 128(1): 71-77.
19. Cosculluela PE, Ebert AM, Varner KE. Dorsomedial bridge plating of Lisfranc injuries. Techniques in Foot and Ankle Surgery, 2009, 8(4): 215-220.
20. Cottom JM, Hyer CF, Berlet GC. Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases. J Foot Ankle Surg, 2008, 47(3): 250-258.
21. Panchbhavi VK, Vallurupalli S, Yang J, et al. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg (Am), 2009, 91(5): 1143-1148.

《中國修復重建外科雜志》

無頭加壓空心螺釘治療Lisfranc損傷的臨床及影像學療效評估

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《中國修復重建外科雜志》

無頭加壓空心螺釘治療Lisfranc損傷的臨床及影像學療效評估

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