使用可调节双侧外固定架分期手术治疗开放性Lisfranc骨折脱位：21例患者的回顾性研究
Staged surgical treatment of open Lisfranc fracture dislocations using an adjustable bilateral external fixator: A retrospective review of 21 patients.
作者信息
Liu Xi, An Jingjing, Chen Yu, Deng Wei, An Xuemei, Zhang Hui
机构信息
Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Orthopaedic Surgery, Shangjin Nanfu Hospital, Chengdu, Sichuan Province, China.
出版信息
Acta Orthop Traumatol Turc. 2020 Sep;54(5):488-496. doi: 10.5152/j.aott.2020.19221.
OBJECTIVE
The aim of this study was to assess the early operative results of a staged progressive reduction technique using a bilateral external fixator in the treatment of patients with open Lisfranc fracture dislocations.
METHODS
In this retrospective study, 21 patients (5 women and 16 men; mean age=44.4 years; age range=24 to 69 years) with open Lisfranc fracture dislocations were included. All the patients were treated in a staged manner from 2012 to 2015. The mean follow-up was 15.4 months (range=12 to 24 months). A two-stage surgical protocol was performed for each patient. At the first stage, a bilateral spanning external fixator was applied across the injured Lisfranc joint, and the length of the disrupted columns was restored by distraction process. Vacuum-assisted closure was used if required. At the second stage, the external fixator was removed, and open reduction and internal fixation were carried out. The time interval between the first and second stages and postoperative complications were documented. To assess the functional status of the patients, the visual analog scale (VAS) and the American Orthopaedic Foot - Ankle Society (AOFAS) midfoot scale were measured at the final follow-up. Radiographic parameters indicating the alignment of the midfoot after the second operation were examined.
RESULTS
Deep infection in one patient and superficial infection in 2 patients were observed. Venous thrombosis was detected in 3 patients. The mean interval between the first and second stages was 18.6 days (range=8 to 48 days). The first metatarso-cuneiform step-off (p=0.002) and the second metatarso-cuneiform step-off (p=0.000) significantly improved at the final follow-up. The mean VAS score was 2.4 (range=0-5), and the mean AOFAS score was 76.3 (range=63 to 97). Primary arthrodesis was performed in seven patients, and six of the remaining 14 patients developed post-traumatic arthritis.
CONCLUSION
With a low risk of complications, the staged progressive reduction protocol using an adjustable bilateral external fixator can be an effective treatment to achieve and maintain anatomic reduction for patients with open Lisfranc fracture dislocations in a short-time follow-up.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
本研究旨在评估采用双侧外固定器的分期渐进性复位技术治疗开放性Lisfranc骨折脱位患者的早期手术效果。
方法
本回顾性研究纳入了21例开放性Lisfranc骨折脱位患者（5例女性，16例男性；平均年龄44.4岁；年龄范围24至69岁）。所有患者于2012年至2015年接受分期治疗。平均随访时间为15.4个月（范围12至24个月）。对每位患者实施两阶段手术方案。第一阶段，在受伤的Lisfranc关节上应用双侧跨关节外固定器，通过牵引过程恢复受损柱的长度。如有需要，使用负压封闭引流。第二阶段，拆除外固定器，进行切开复位内固定。记录第一阶段和第二阶段之间的时间间隔以及术后并发症。为评估患者的功能状态，在末次随访时测量视觉模拟评分（VAS）和美国矫形足踝协会（AOFAS）中足评分。检查第二次手术后表明中足对线情况的影像学参数。
结果
观察到1例患者发生深部感染，2例患者发生浅表感染。3例患者检测到静脉血栓形成。第一阶段和第二阶段之间的平均间隔时间为18.6天（范围8至48天）。在末次随访时，第一跖楔关节台阶差（p = 0.002）和第二跖楔关节台阶差（p = 0.000）有显著改善。平均VAS评分为2.4（范围0至5），平均AOFAS评分为76.3（范围63至97）。7例患者进行了一期关节融合术，其余14例患者中有6例发生创伤后关节炎。
结论
采用可调节双侧外固定器的分期渐进性复位方案并发症风险较低，在短期随访中可为开放性Lisfranc骨折脱位患者实现并维持解剖复位提供一种有效的治疗方法。
证据水平
IV级，治疗性研究。
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