Lau Simon, Howells Nicholas, Millar Michael, De Villiers Daniel, Joseph Samuel, Oppy Andrew
Orthopaedic Resident, Royal Melbourne Hospital, Parkville, VIC, Australia.
Orthopaedic Fellow, Royal Melbourne Hospital, Parkville, VIC, Australia.
J Foot Ankle Surg. 2016 Jul-Aug;55(4):799-802. doi: 10.1053/j.jfas.2016.03.002. Epub 2016 Apr 12.
Traditionally, Lisfranc fracture dislocations have been treated with transarticular screw fixation. A more recent development has been the use of dorsal bridging plates. The aim of the present study was to compare the radiologic outcomes for these 2 methods. Currently, no data comparing the outcomes of these 2 treatment options have been reported. A total of 62 patients were treated for Lisfranc fracture dislocations during a 6-year period. The inclusion criteria included ≥6 months of follow-up data available. Each fracture was classified using the Hardcastle classification system. Each fracture was also allocated into 1 of 4 groups: transarticular screw fixation, dorsal plating, a combination of plate and screw fixation, and nonoperative management. The outcome measures included the Kellgren-Lawrence grading of osteoarthritis and the Wilppula classification of anatomic reduction. In terms of results, radiologic osteoarthritis is not associated with the type of injury according to the Hardcastle classification nor with having an open or closed fracture. The Hardcastle classification is not associated with the type of fixation used. Fractures fixed with a combination of plates and screws had a 3.01 (95% confidence interval 1.036 to 8.74) increased risk of having stage 3 or 4 radiologic osteoarthritis compared with being fixed solely with bridging plates (p = .009). Multivariate analysis revealed that this increased risk of osteoarthritis was dependent on the quality of reduction, with good reductions having a 18.2 (95% confidence interval 15.9 to 21.8) times decreased risk of severe osteoarthritis compared with fair or poor reductions, independent of the type of fixation used (p < .0001). No radiologic benefits were found when comparing plate or screw fixation for Lisfranc fracture dislocations (although screw fixation might be associated with a less planus foot and fewer complications). Instead, a good anatomic reduction was the only predictor of the radiologic outcome, and the Hardcastle classification of fractures did not predict the surgery type or radiologic outcome. Finally, treatment with combination plates and screws resulted in worse radiologic outcomes, possibly owing to more complex fracture patterns.
传统上，Lisfranc骨折脱位采用经关节螺钉固定治疗。最近的一项进展是使用背侧桥接钢板。本研究的目的是比较这两种方法的影像学结果。目前，尚无比较这两种治疗方案结果的数据报道。在6年期间，共有62例患者接受了Lisfranc骨折脱位治疗。纳入标准包括有≥6个月的可用随访数据。每个骨折均使用Hardcastle分类系统进行分类。每个骨折还被分为4组中的1组：经关节螺钉固定、背侧钢板固定、钢板和螺钉联合固定以及非手术治疗。结果测量指标包括骨关节炎的Kellgren-Lawrence分级和解剖复位的Wilppula分类。就结果而言，根据Hardcastle分类，影像学骨关节炎与损伤类型无关，也与开放性或闭合性骨折无关。Hardcastle分类与所使用的固定类型无关。与单纯使用桥接钢板固定相比，采用钢板和螺钉联合固定的骨折发生3或4期影像学骨关节炎的风险增加3.01倍（95%置信区间为1.036至8.74）（p = 0.009）。多因素分析显示，这种骨关节炎风险增加取决于复位质量，与复位一般或较差相比，复位良好的患者发生严重骨关节炎的风险降低18.2倍（95%置信区间为15.9至21.8），与所使用的固定类型无关（p < 0.0001）。比较Lisfranc骨折脱位的钢板或螺钉固定时，未发现影像学上的益处（尽管螺钉固定可能与扁平足较轻和并发症较少有关）。相反，良好的解剖复位是影像学结果的唯一预测因素，骨折的Hardcastle分类不能预测手术类型或影像学结果。最后，钢板和螺钉联合治疗导致更差的影像学结果，可能是由于骨折模式更复杂。
