Gu Wenqi, Shi Zhongmin
Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Medicine (Baltimore). 2017 Apr;96(17):e6699. doi: 10.1097/MD.0000000000006699.
There are still controversies on the management and outcome of open Lisfranc injury in available studies. This study evaluates the staged management of Lisfranc injury and its complications.Patients who received a staged strategy for open Lisfranc injury were reviewed.One patient with degloving injury suffered from partial skin and hallux necrosis which was treated by debridement, hallux amputation, definitive internal fixation, and local flap transfer on the 12th day after first stage management. A definitive internal fixation and simultaneous skin graft or flap coverage were performed in another 3 patients with soft tissue defects. Other patients without soft tissue problems underwent a second stage of definitive internal fixation. Bone union was observed on the 12.5th week after definitive surgery. The median AOFAS midfoot score at the last follow-up was 74.4 ± 8.7, while the average VAS score was 2.2 ± 1.8. The average return-to-work time was 8th months postoperatively in 9 patients. Flap necrosis, infection, implant failure, nonunion, and osteomyelitis were not observed during the follow-up. Two patients received Lisfranc arthrodesis for persistent pain due to posttraumatic arthritis.In the management of open Lisfranc injury, surgeons must consider soft tissue condition. Staged strategy is a rational protocol for this severe injury. Temporary K-wire fixation after early radical debridement and realignment will facilitate the definitive internal fixation until soft tissue condition improves, which also can decrease the soft tissue complication.
在现有研究中，对于开放性Lisfranc损伤的治疗及预后仍存在争议。本研究评估Lisfranc损伤的分期治疗及其并发症。回顾接受开放性Lisfranc损伤分期治疗策略的患者。1例脱套伤患者出现部分皮肤和拇趾坏死，在第一阶段治疗后第12天接受清创、拇趾截肢、确定性内固定和局部皮瓣转移治疗。另外3例有软组织缺损的患者进行了确定性内固定并同时进行植皮或皮瓣覆盖。其他无软组织问题的患者接受了第二阶段的确定性内固定。在确定性手术后第12.5周观察到骨愈合。末次随访时AOFAS中足评分中位数为74.4±8.7，而VAS评分平均为2.2±1.8。9例患者术后平均重返工作时间为8个月。随访期间未观察到皮瓣坏死、感染、内固定失败、骨不连和骨髓炎。2例患者因创伤后关节炎持续疼痛接受了Lisfranc关节融合术。在开放性Lisfranc损伤治疗中，外科医生必须考虑软组织情况。分期治疗策略是针对这种严重损伤的合理方案。早期彻底清创和复位后临时克氏针固定将有助于进行确定性内固定，直到软组织情况改善，这也可减少软组织并发症。
