Park Young Hwan, Ahn Jeong Hwan, Choi Gi Won, Kim Hak Jun
Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
Orthopaedic Resident, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
J Foot Ankle Surg. 2020 Sep-Oct;59(5):914-918. doi: 10.1053/j.jfas.2019.10.013. Epub 2020 Apr 25.
To use the advantages of transarticular screw fixation while minimizing iatrogenic involved joint damage and screw irritation, it is important to determine the screw size. The aim of this study was to analyze the outcomes of percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries and determine whether the procedure is a safe alternative to traditional screw fixation using a larger screw size. A review was performed for all patients who underwent percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries at a single institution over a 6-year period. Thirty-one patients were enrolled in this study. Patients were assessed clinically and radiographically for demographics, foot function index (FFI), numerical rating scale (NRS) for pain, patient satisfaction, and complication rates. Factors affecting screw breakage and its clinical relevance were also analyzed. The FFI and NRS for pain were 17.2 ± 14.7 (range 0.8 to 57.8) and 3.1 ± 2.3 (range 0 to 8) points, respectively, at the 12-month follow-up visit. One patient (3.2%) underwent arthrodesis for the development of posttraumatic arthritis; all other patients recovered without sequelae. Screw breakage was identified in 7 patients (22.6%). There was no significant difference between patients with and without screw breakage in terms of FFI, NRS for pain, patient satisfaction, or complication rate. Body mass index (BMI) was significantly higher in patients with screw breakage than in those without screw breakage. Receiver operator characteristics curve analysis demonstrated a strong relationship between BMI and screw breakage (area under the curve = 90%, p < .001), and the potential BMI cutoff value was 27.8 kg/m. After considering the incidence of screw breakage, percutaneous reduction and 2.7-mm cortical screw fixation can be a viable option for treating low-energy Lisfranc injuries in nonobese patients, especially those with BMI <27.8 kg/m.
为了利用经关节螺钉固定的优势，同时将医源性关节损伤和螺钉刺激降至最低，确定螺钉尺寸很重要。本研究的目的是分析经皮复位和2.7毫米皮质骨螺钉固定治疗低能量Lisfranc损伤的效果，并确定该手术是否是使用更大尺寸螺钉的传统螺钉固定的安全替代方法。对在一家机构接受经皮复位和2.7毫米皮质骨螺钉固定治疗低能量Lisfranc损伤的所有患者进行了为期6年的回顾性研究。本研究纳入了31例患者。对患者进行临床和影像学评估，以了解人口统计学、足部功能指数（FFI）、疼痛数字评定量表（NRS）、患者满意度和并发症发生率。还分析了影响螺钉断裂的因素及其临床相关性。在12个月的随访中，疼痛的FFI和NRS分别为17.2±14.7（范围0.8至57.8）和3.1±2.3（范围0至8）分。1例患者（3.2%）因创伤后关节炎发展而行关节融合术；所有其他患者均康复且无后遗症。7例患者（22.6%）出现螺钉断裂。在FFI、疼痛NRS、患者满意度或并发症发生率方面，有螺钉断裂和无螺钉断裂的患者之间无显著差异。有螺钉断裂的患者的体重指数（BMI）显著高于无螺钉断裂的患者。受试者工作特征曲线分析表明BMI与螺钉断裂之间存在密切关系（曲线下面积=90%，p<0.001），潜在的BMI临界值为27.8kg/m²。考虑到螺钉断裂的发生率后，经皮复位和2.7毫米皮质骨螺钉固定对于治疗非肥胖患者，尤其是BMI<27.8kg/m²的低能量Lisfranc损伤可能是一种可行的选择。
