1、骨与关节损伤切开复位内固定术治疗骰骨压缩性骨折外侧柱Lisfranc 损伤的临床疗效及并发症影响因素分析鲍沁蔚，李茂林，巫宗德，刘亮，魏国华，彭亮，刘峻宏，张强四川省骨科医院足踝创伤科，成都610041【基金项目】四川省干部保健科研课题(川干研 2021 604)【通信作者】张强，E-mail:bqw875163 com【摘要】目的探究切开复位内固定术对合并骰骨压缩性骨折外侧柱 Lisfranc 损伤的治疗效果，分析术后并发症的影响因素。方法前瞻性选择笔者医院 2016 年 3 月2021 年 8 月收治的合并骰骨压缩骨折的外侧柱 Lisfranc 损伤患者 108 例，其中男性 72 例，女
2、性 36 例;年龄 18 78 岁，平均 42 4 岁;致伤原因:道路交通伤 42 例，挤压伤 26 例，跌落伤 30 例，其他 10 例。待患者软组织条件达标后择期行切开复位微型钢板及螺钉内固定手术治疗。对患者进行术后 3、6 个月及 1 年门诊随访，评估患者复位效果。采用美国足踝外科协会踝与后足功能(American Orthopaedic Foot Ankle Society，AOFAS)评分、疼痛视觉模拟评分(visualanalogue scale，VAS)评估患者恢复情况。记录患者术后 1 年内出现创伤性关节炎、功能受限、感染、肿胀、切口不愈合等并发症发生率。根据术后 1 年是否出
3、现并发症分为无并发症组和并发症组，结合患者临床资料分析并发症影响因素。结果87 例术后 3 个月被评估为解剖复位，17 例被评估为近解剖复位，4 例被评估为非解剖复位。与治疗前相比 力线(5 11 1 16)分、功能(19 37 4 12)分、疼痛(18 42 4 14)分以及AOFAS 总分(42 90 8 14)分，治疗后力线(13 48 1 30)分、功能(36 36 4 99)分、疼痛(32 56 5 26)分以及 AOFAS 总分(82 40 9 48)分 均有明显升高，差异有统计学意义(P 0 05)。术后 VAS(3 320 84)分低于术前(7 28 1 66)分，P 0 05
4、。术后 1 年，18 例患者出现并发症，并发症发生率为16 67%。并发症组年龄、饮酒、糖尿病、受伤至入院时间、Quenu-Kuss 分型与无并发症组比较差异有统计学意义(P 0 05)。Logistic 回归分析显示年龄、饮酒、糖尿病、Quenu-Kuss 分型是术后并发症发生的独立危险因素(P 0 05)。结论切开复位内固定对于合并骰骨压缩性骨折的 Lisfranc 损伤有较好的治疗效果，年龄、饮酒、糖尿病、Quenu-Kuss 分型是术后出现并发症的主要影响因素。【关键词】骰骨压缩性骨折;内固定;Lisfranc 损伤;疗效;并发症【中图分类号】683 42【文献标识码】A【DOI】10
5、 3969/j issn 1009 4237 2023 08 009Open reduction and internal fixation for the treatment of lateral column Lisfranc injuriescombined with cuboid compressibility fractures and risk factors for complicationsBao Qinwei，Li Maolin，Wu Zongde，Liu Liang，Wei Guohua，Peng Liang，Liu Junhong，Zhang QiangDepartmen
6、t of Foot and Ankle Traumatology，Sichuan Orthopaedic Hospital，Chengdu610041，China【Abstract】ObjectiveTo explore the therapeutic effect of open reduction and internal fixation on Lisfrancinjuries of the lateral column combined with cuboid compression fractures，and to analyze the influencing factors of
7、postoperative complications MethodsA total of 108 patients with Lisfranc injuries of the lateral column combinedwith cuboid compression fractures were prospectively selected from our hospital between Mar 2016 and Aug 2021，including 72 male and 36 female aged 18-78 years，mean 42 4 years The injury ca
8、uses were road traffic accidentsin 42 patients，crush injuries in 26，falls in 30 and others in 10 After the soft tissue conditions of patients reachedthe required standard，open reduction and internal fixation was performed Patients were followed up at 3，6 monthsand 1 year after operation when the red
9、uction level was evaluated The ankle and hind foot function score by the A-merican Orthopaedic Foot Ankle Society(AOFAS)and pain by visual analogue scale(VAS)of were used to eval-uate the recovery of patients The incidence of traumatic arthritis，functional limitation，muscle atrophy，internal fixa-tio
10、n failure，infection and other complications were recorded within 1 year after operation Then patients were dividedinto complication group and non-complication group，to further explore the risk factors for the incidence of complica-806创伤外科杂志 2023 年第 25 卷第 8 期J Trauma Surg，2023，Vol 25，No 8tions esults
11、Among the 108 patients，87(80 56%)were evaluated as anatomical reduction，17(15 74%)asnear anatomical reduction，and 4(3 70%)as non-anatomical reduction at 3 months after surgery Compared withbefore surgery，open reduction and internal fixation significantly improved the AOFAS scores，respectively in ter
12、ms offorce line(5 11 1 16 vs 13 48 1 30)，function(1937 412 vs 3636 499)，pain(1842 414 vs 32565 26)and total score(42 90 8 14 vs 82 40 9 48)and the differences were significant(all P 0 05)TheVAS significantly decreased after operation(7 28 1 66 vs 3 32 0 84，P 0 05)Within one year follow-up，18 patient
13、s developed complications，with the incidence being 16 67%Comparion between the complication andnon-complication groups revealed significant differences in age，alcohol consumption，diabetes，time from injury to ad-mission and Quenu Kuss classification(all P 0 05)Further logistic regression analysis sho
14、wed that all of themwere risk factors for postoperative complications except for time from injury to admission ConclusionOpen reduc-tion and internal fixation can well manage Lisfranc injuries of the lateral column combined with cuboid compressionfractures Age，alcohol consumption，diabetes and Quenu
15、Kuss classification are risk factors for postoperative compli-cations【Key words】Compression fractures of cuboid bone;Internal fixation;Lisfranc injuries;Curativeeffect;ComplicationLisfranc 损伤最早由法国军医 Jacques Lisfranc提出并命名，现代医学将 Lisfranc 损伤定义为跗跖关节脱位、骨折1。Lisfranc 损伤是临床足踝创伤治疗的一个难点，单独治疗 Lisfranc 损伤时步骤较简单
16、，临床已积累了较多经验。随着我国交通与工业的发展，骰骨压缩骨折合并 Lisfranc 损伤发生率逐渐升高2。从解剖学方面分析，骰骨在外力作用下受远端跖骨基底与近端跟骨前部的挤压后容易出现压缩性骨折，此类骨折容易导致外侧柱缩短3。在临床治疗过程，医务人员通常会更加关注 Lisfranc损伤，忽略骰骨压缩性骨折的治疗，导致患者术后可能出现骨折不愈合或畸形愈合，对关节功能恢复影响较大4 5。本研究采用前瞻性研究方式，选择笔者医院 2016 年 3 月2021 年 8 月收治的合并骰骨压缩性骨折的 Lisfranc 损伤患者 108 例，采用切开复位内固定术进行治疗，开展为期 1 年的术后门诊随访，分析其治疗效果以及影响术后并发症的因素。临床资料1一般资料纳入标准:(1)符合骨科疾病诊断标准6 中关于骰骨压缩骨折与 Lisfranc 损伤的定义;(2)入院经影像学检查(X 线片、CT 等)明确诊断为合并骰骨压缩性骨折的 Lisfranc 损伤;(3)存在移位的新鲜骰骨压缩骨折，新鲜骨折定义为受伤至入院时间在14d 以内，移位超过 2mm;(4)年龄18 周岁，能够独立完成相关随访评估;(5)视