Fan Meng-Qiang, Li Xu-Song, Jiang Xian-Jun, Shen Jian-Jian, Tong Pei-Jian, Huang Jie-Feng
Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China.
Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan 528401, Guangdong, China.
Injury. 2019 Feb;50(2):571-578. doi: 10.1016/j.injury.2018.12.023. Epub 2018 Dec 18.
This study assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures. Metatarsal fractures here refers to metatarsal head, neck, and shaft (including shaft fractures accompanied by fractures of the base) fractures, as well as mixed (i.e., segmental fracture) fractures, as seen on imaging studies.
Between 2002 and 2015, one hundred and seventy-six patients were followed-up for a mean of 92 months, including eight patients who underwent secondary arthrodesis due to severe arthritis after ORIF. All the patients underwent surgical fusion (primary partial arthrodesis, PPA; n = 78) or non-fusion (percutaneous or open reduction and internal fixation, ORIF; n = 98) procedures and the outcomes were evaluated by clinical examinations, radiography, visual analogue scale (VAS) pain score, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, the Foot and Ankle Outcome Score (FAOS), and the Short Form (SF)-36 physical and SF-36 mental questionnaires. The parameters between the fusion and non-fusion groups were analyzed by repeated-measures ANOVA. Statistically significant differences between the two groups were then further analyzed using a two-independent-samples t-test.
Anatomical reduction was achieved in 161 patients. At the last follow-up, the mean AOFAS score was 74.67 (range: 39-91) in the non-fusion group and 82.79 (range: 67-97) in the fusion group (P = 0.003). The PPA and ORIF groups differed significantly with respect to the VAS pain score (1.93 vs. 1.21), the SF-36 physical (75.87 vs. 80.90) and mental (75.76 vs. 81.33) components, and the FAOS pain (72.74 vs. 84.06), symptoms (71.87 vs. 82.49), activities of daily life (ADLs: 73.12 vs. 81.54), sport/recreation (sport/rec: 57.99 vs. 73.23), and quality of life (QoL: 79.95 vs. 86.67) components. In the ORIF group, 23 patients had mild/moderate post-traumatic osteoarthritis.
With longer and more conservative postoperative management, fusion results in a better outcome than non-fusion in the treatment of Lisfranc injuries accompanied by multiple metatarsal fractures.
本研究评估了伴有多发跖骨骨折的Lisfranc损伤的手术疗效。此处的跖骨骨折是指跖骨头、颈和骨干（包括伴有基底骨折的骨干骨折）骨折，以及影像学检查所见的混合性（即节段性骨折）骨折。
2002年至2015年期间，对176例患者进行了平均92个月的随访，其中包括8例因切开复位内固定术后严重关节炎而接受二次关节融合术的患者。所有患者均接受了手术融合（一期部分关节融合术，PPA；n = 78）或非融合（经皮或切开复位内固定，ORIF；n = 98）手术，并通过临床检查、X线摄影、视觉模拟量表（VAS）疼痛评分、美国矫形足踝协会（AOFAS）中足评分、足踝结局评分（FAOS）以及简明健康调查问卷（SF-36）身体和精神问卷对疗效进行评估。采用重复测量方差分析对融合组和非融合组之间的参数进行分析。然后使用两独立样本t检验对两组之间的统计学显著差异进行进一步分析。
161例患者实现了解剖复位。在最后一次随访时，非融合组的平均AOFAS评分为74.67（范围：39 - 91），融合组为82.79（范围：67 - 97）（P = 0.003）。PPA组和ORIF组在VAS疼痛评分（1.93对1.21）、SF-36身体（75.87对80.90）和精神（75.76对81.33）分量表、FAOS疼痛（72.74对84.06）、症状（71.87对82.49）、日常生活活动（ADLs：73.12对81.54）、运动/娱乐（sport/rec：57.99对73.23）以及生活质量（QoL：79.95对86.67）分量表方面存在显著差异。在ORIF组中，23例患者患有轻度/中度创伤后骨关节炎。
对于伴有多发跖骨骨折的Lisfranc损伤，术后进行更长时间且更保守的管理时，融合术的治疗效果优于非融合术。
