Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, China.
Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, China.
Int Orthop. 2022 Nov;46(11):2529-2537. doi: 10.1007/s00264-022-05478-y. Epub 2022 Jun 20.
Open reduction and internal fixation (ORIF) is a popular method for treatment of displaced Lisfranc injuries. However, even with anatomic reduction and solid internal fixation, treatment does not provide good outcomes in certain severe dislocations. The purpose of this study was to compare ORIF and primary arthrodesis (PA) of the first tarsometatarsal (TMT) joint for Lisfranc injuries with the first TMT joint dislocation.
Seventy-eight Lisfranc injuries with first TMT joint dislocation were finally enrolled and analyzed in a prospective, randomized trial comparing ORIF and PA. They were 50 males and females with a mean age of 40.7 years and randomized to ORIF group and PA group. Outcome measures included radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, Foot and Ankle Ability Measure (FAAM) Sports subscale, visual analog scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Complications and revision rate were also analyzed.
Forty patients were treated by ORIF, while PA group includes 38 cases. Patients were followed up for 37.8(range, 24-48) months. At final follow-up, the mean AOFAS midfoot score (P < 0.01), the FAAM Sports subscale (P < 0.01), the physical function score (P < 0.05), and the Bodily Pain score of SF-36 (P < 0.05) after ORIF treatment were significantly lower than PA group. The mean VAS score in ORIF group was higher (P < 0.01). In ORIF group, redislocation of the first TMT joint was observed in ten cases, and thirteen patients had pain in midfoot. No redislocation and no hardware failure were identified in PA group.
PA of the first TMT joint provided a better medium-term outcome than ORIF for Lisfranc injuries with the first TMT dislocation. Possible complications and revision could be avoided by PA for dislocated first ray injuries.
切开复位内固定（ORIF）是治疗跖跗关节（Lisfranc）损伤的常用方法。然而，即使解剖复位和牢固的内固定，在某些严重脱位的情况下，治疗效果也不理想。本研究的目的是比较切开复位内固定和第一跖楔关节（TMT）融合术治疗第一跖骨间关节脱位的 Lisfranc 损伤。
最终纳入并前瞻性随机试验比较切开复位内固定和跖楔关节融合术的 78 例第一跖骨间关节脱位的 Lisfranc 损伤患者。男女比例为 50:28，平均年龄为 40.7 岁，随机分为切开复位内固定组和跖楔关节融合术组。观察指标包括影像学、美国矫形足踝协会（AOFAS）中足评分、足踝能力测量（FAAM）运动亚量表、视觉模拟评分（VAS）和 36 项简明健康调查量表（SF-36）。同时还分析了并发症和翻修率。
40 例患者接受切开复位内固定治疗，38 例患者接受跖楔关节融合术。患者随访 37.8（24-48）个月。末次随访时，切开复位内固定组的 AOFAS 中足评分（P<0.01）、FAAM 运动亚量表（P<0.01）、躯体功能评分（P<0.05）和 SF-36 躯体疼痛评分（P<0.05）明显低于跖楔关节融合术组，切开复位内固定组的 VAS 评分较高（P<0.01）。切开复位内固定组中，10 例患者出现第一跖楔关节再脱位，13 例患者出现中足疼痛。跖楔关节融合术组未出现再脱位和内固定失败。
与切开复位内固定相比，第一跖楔关节融合术可为第一跖骨间关节脱位的 Lisfranc 损伤提供更好的中期疗效。对于第一跖骨间关节脱位的损伤，跖楔关节融合术可避免可能的并发症和翻修。
