摘要
目的比较背侧入路和内侧入路对Lisfranc损伤的疗效。方法采用回顾性队列研究分析2017年1月到2021年12月同济大学附属同济医院收治的43例闭合性Lisfranc损伤患者的临床资料。手术方式为骨折切开复位内固定或跖楔关节融合。依据手术入路的不同,分为背侧入路组(23例)和内侧入路组(20例)。记录比较两组患者的手术时间,切口并发症,内固定丢失情况,内固定取出率,患者的临床满意度以及术前和末次随访时美国足踝外科协会(AOFAS)评分和疼痛视觉模拟评分(VAS)。结果43例患者中,男33例,女10例,年龄为(45.2±13.4)岁。患者均获得随访,随访时间为(17.9±6.7)个月,两组基线资料具有可比性。术前,背侧入路组和内侧入路组AOFAS评分分别为(30.3±10.7)分和(28.5±9.3)分,VAS评分则分别为(6.2±1.9)分和(6.3±2.1)分(均P>0.05),两组手术时间分别为(112.2±25.0)min和(91.0±22.5)min(P=0.006)。背侧入路组2例患者切口出现浅表感染,内侧入路组1例患者延迟愈合,其余患者均为Ⅰ期愈合。背侧入路组3例患者在随访时出现足背长期麻木或疼痛,予以营养神经药物缓解症状;内侧入路组1例患者伤口周围感觉异常,逐步好转。在随访期内,共有10例患者行内固定取出术,其中背侧入路组7例(30.4%),内侧入路组3例(15.0%)(P=0.294)。末次随访时,背侧入路组和内侧入路组AOFAS评分分别为(83.8±7.7)分和(86.7±6.9)分(P=0.207);VAS评分则分别为(2.1±1.0)分和(1.3±0.5)分(P=0.002),均较术前改善(均P<0.001)。两组患者内固定均在位,无内固定丢失情况。背侧入路有3例(13.0%)患者对手术效果不满意,内侧入路组有1例(5%)患者不满意(P=0.848)。结论两种手术入路均能获得良好的预后,二者在固定效果上相当,内侧入路组在手术时间、内固定取出率、VAS评分和患者临床满意度上优于背侧入路。
Objective To compare the efficacy of dorsal approach and medial approach in the treatment of Lisfranc injury.Methods A retrospective cohort study was conducted to analyze the clinical data of 43 patients with closed Lisfranc injuries admitted to Tongji Hospital of Tongji University from January 2017 to December 2021.The surgical approach were open reduction and internal fixation or metatarsal cuneiform joint fusion,with 23 cases using the dorsal approach and 20 cases using the medial approach.The duration of surgery,incisional complications,loss of internal fixation,internal fixation removal rate,patient′s clinical satisfaction,and American Orthopedic Foot and Ankle Society(AOFAS)score and visual analogue scale(VAS)score of pain in the patients were reviewed based on the medical record system and follow‑up records.Results Of the patients,33 were male and 10 were female,with a mean age of(45.2±13.4)years.All the patients were followed up for(17.9±6.7)months,and there was no statistically significant differences in the baseline data between the two groups.Preoperatively,the dorsal approach group and the medial approach group had a AOFAS score of(30.3±10.7)and(28.5±9.3),respectively,and a VAS score of(6.2±1.9)and(6.3±2.1),respectively(both P>0.05);the operation time was(112.2±25.0)min and(91.0±22.5)min,respectively in the two groups(P=0.006).Two patients in the dorsal approach group developed superficial infection in the incision,one patient experienced delayed healing in the medial approach group,while the remaining patients achieved primary healing.In the dorsal approach group,three patients suffered long‑term numbness or pain on the dorsum of the foot during follow‑up,which was alleviated with neurotrophic medications;in the medial approach group,one patient had abnormal sensations around the wound site,which gradually improved.During the follow‑up period,a total of 10 patients underwent internal fixation removal,including 7 patients(30.4%)in the dorsal approach group and 3 patients(15.0%)in the medial approach group(P=0.294).The AOFAS score in the dorsal approach group and the medial approach group at the last follow‑up was 83.8±7.7 and 86.7±6.9(P=0.207),and the VAS scores was 2.1±1.0 and 1.3±0.5(P=0.002),respectively,both showed improvement when compared with those before the surgery(both P<0.001).In both groups,the internal fixations were all in place,with no cases of lost implants.In the dorsal approach group,3 patients(13.0%)were dissatisfied with the surgical outcome,while in the medial approach group,1 patient(5%)was dissatisfied(P=0.848).Conclusions Both surgical approaches resulted in a good prognosis,and there is no statistical difference between the two groups in terms of fixation effect,and the medial approach group is superior to the dorsal access in operative time,internal fixation removal rate,VAS score and patient clinical satisfaction.
作者
李振东
夏江
和文宝
周海超
陈城
张艺
赵有光
李兵
杨云峰
Li Zhendong;Xia Jiang;He Wenbao;Zhou Haichao;Chen Cheng;Zhang Yi;Zhao Youguang;Li Bing;Yang Yunfeng(Department of Orthopedics,Shanghai Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Orthopedics,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中华医学杂志》
CSCD
北大核心
2024年第47期4297-4302,共6页
National Medical Journal of China
基金
国家重点研发计划(2022YFC2009505)
上海市科技计划(22S31900300)。
