Kuo R S, Tejwani N C, Digiovanni C W, Holt S K, Benirschke S K, Hansen S T, Sangeorzan B J
Department of Orthopaedics, Harborview Medical Center, Seattle, Washington 98104, USA.
J Bone Joint Surg Am. 2000 Nov;82(11):1609-18. doi: 10.2106/00004623-200011000-00015.
Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management.
We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. Among ninety-two adults treated for that injury, forty-eight patients with forty-eight injuries were followed for an average of fifty-two months (range, thirteen to 114 months). Fifteen injuries were purely ligamentous, and thirty-three were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score.
The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 points, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six of them required arthrodesis. The major determinant of a good result was anatomical reduction (p = 0.05). The subgroup of patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation.
Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores.
切开复位内固定术已被推荐用于治疗多数Lisfranc（跗跖）关节的不稳定损伤。一直以来，人们认为即使进行了这样的手术治疗，单纯韧带损伤的预后也较差。
我们对7年间接受Lisfranc损伤切开复位螺钉固定术的患者进行了一项回顾性研究。在92例接受该损伤治疗的成人患者中，48例患者的48处损伤接受了平均52个月（范围为13至114个月）的随访。15处损伤为单纯韧带损伤，33处为韧带和骨联合损伤。采用美国矫形足踝协会（AOFAS）中足评分和肌肉骨骼功能评估长表（MFA）评分对患者的预后进行评估。
AOFAS中足评分平均为77分（满分0至100分，100分表示预后极佳），患者因轻度疼痛、娱乐功能下降和矫形需求而失分。MFA评分平均为19分（满分0至100分，0分表示预后极佳），患者因“休闲活动”问题以及“因损伤导致的生活变化和感受”困难而失分。12例患者（25%）发生了跗跖关节创伤性骨关节炎，其中6例需要进行关节融合术。良好预后的主要决定因素是解剖复位（p = 0.05）。尽管进行了解剖复位和螺钉固定，但单纯韧带损伤患者亚组的预后仍有较差的趋势。
我们的结果支持这样的观点，即Lisfranc关节骨折脱位的稳定解剖复位可带来最佳的长期预后，因为接受如此治疗的患者关节炎较少，AOFAS中足评分也更好。
