Dubois-Ferrière Victor, Lübbeke Anne, Chowdhary Ashwin, Stern Richard, Dominguez Dennis, Assal Mathieu
Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland
Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland.
J Bone Joint Surg Am. 2016 May 4;98(9):713-20. doi: 10.2106/JBJS.15.00623.
Injuries to the tarsometatarsal (TMT) joint complex, or Lisfranc injuries, have been reported to result in osteoarthritis (OA) following surgical treatment. Good outcomes with respect to short and medium-term results have been reported. However, long-term results, specifically regarding clinical outcomes and the development of symptomatic OA, are limited. The objectives of this study were to assess clinical outcomes, the occurrence of symptomatic OA, and risk factors for OA at 2 to 24 years after a Lisfranc injury treated surgically with open reduction and internal fixation (ORIF) or with primary arthrodesis.
This was a retrospective study involving 61 patients treated surgically at our institution between 1988 and 2009 for an injury to the TMT joint complex. Patients underwent either ORIF with transarticular screws or primary arthrodesis when joint comminution at the TMT level was such that ORIF was not possible. Functional outcomes were assessed according to the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot Function Index (FFI), and a visual analog scale (VAS) for pain. Global health was evaluated with the Short Form (SF)-12 Health Survey physical component summary (PCS).
Sixty-one of the 128 patients were available for clinical evaluation, including the use of questionnaires, and radiographic assessment at a mean of 10.9 years postoperatively (range, 2.4 to 23.9 years). Mean scores were as follows: AOFAS score, 79.0; FFI, 16.9, and VAS for pain, 2.5. Radiographic evidence of OA was noted in 44 (72.1%) of the patients, and symptomatic OA, in 54.1%, the latter having worse outcomes. Risk factors for OA were nonanatomic reduction, fracture classification of Myerson type C, and a history of smoking.
Two to 24 years following surgical treatment to restore and maintain joint anatomy for Lisfranc injuries, we found satisfactory clinical outcome scores and a large number of patients who had returned to their previous level of functioning and employment, with little need for secondary procedures. However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
据报道，跗跖关节（TMT）复合体损伤，即Lisfranc损伤，在手术治疗后会导致骨关节炎（OA）。已有关于短期和中期结果的良好报道。然而，长期结果，特别是关于临床结果和症状性OA的发展，是有限的。本研究的目的是评估手术切开复位内固定（ORIF）或一期关节融合术治疗Lisfranc损伤后2至24年的临床结果、症状性OA的发生情况以及OA的危险因素。
这是一项回顾性研究，纳入了1988年至2009年间在我们机构接受手术治疗的61例TMT关节复合体损伤患者。当TMT水平的关节粉碎严重以至于无法进行ORIF时，患者接受经关节螺钉的ORIF或一期关节融合术。根据美国矫形足踝协会（AOFAS）评分、足部功能指数（FFI）和疼痛视觉模拟量表（VAS）评估功能结果。用简短健康调查（SF）-12健康调查身体成分总结（PCS）评估总体健康状况。
128例患者中有61例可进行临床评估，包括问卷调查和术后平均10.9年（范围2.4至23.9年）的影像学评估。平均得分如下：AOFAS评分79.0；FFI 16.9，疼痛VAS 2.5。44例（72.1%）患者有OA的影像学证据，54.1%有症状性OA，后者结果更差。OA的危险因素是非解剖复位、Myerson C型骨折分类和吸烟史。
在对Lisfranc损伤进行手术治疗以恢复和维持关节解剖结构后的2至24年，我们发现临床结果评分令人满意，大量患者恢复到了之前的功能和工作水平，几乎不需要二次手术。然而，创伤后OA的发生率很高，在X线片上很明显，尽管症状性OA的发生率较低。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
