Onochie Elliot, Bua Nelson, Mmerem Kingsley, Heidari Nima, Vris Alexandros, Malagelada Francesc, Parker Lee, Jeyaseelan Luckshmana
Barts Bone and Joint Health, Barts Health NHS Trust, London, United Kingdom.
J Orthop Trauma. 2023 Jan 1;37(1):e22-e27. doi: 10.1097/BOT.0000000000002469.
To assess medium-term functional outcomes and the complication profile for unstable Lisfranc injuries treated with dorsal bridge plate (DBP) fixation when implants are not routinely removed.
Large single-center retrospective case series.
Level-1 Trauma Center, London, United Kingdom.
Consecutive cases of skeletally mature individuals with unstable Lisfranc injuries treated operatively between 2014 and 2019.
Open reduction and DBP fixation with implants not routinely removed.
Patient-reported outcome measures at final follow-up. The Manchester-Oxford Foot Questionnaire summary index was the primary outcome measure. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, complications, and all-cause reoperation rates were secondary outcome measures. Logistic regression models were used to identify risk factors that influenced outcomes.
Eighty-five patients were included. Mean follow-up was 40.8 months (24-72). The mean Manchester-Oxford Foot Questionnaire Summary Index was 27.0 (SD 7.1) and mean AOFAS score 72.6 (SD 11.6). The presence of an intra-articular fracture was associated with poorer outcomes, with worse MOXFQ and AOFAS scores (both P < 0.001). Eighteen patients (21%) required implants removal, with this more likely in female patients (OR 3.89, 95% confidence interval, 1.27 to 12.0, P = 0.02). Eight patients (9%) required secondary arthrodesis.
This is the largest series of Lisfranc injuries treated with DBP fixation reported to-date and the only to routinely retain implants. Medium-term outcomes are comparable to existing literature in which implants are routinely removed. The presence of an intra-articular fracture is a poor prognostic indicator. Implant removal is more likely to be needed in female patients.
Therapeutic Level IV. See Instructions for authors for a complete description of levels of evidence.
评估在不常规取出植入物的情况下，采用背侧桥接钢板（DBP）固定治疗不稳定型Lisfranc损伤的中期功能结局和并发症情况。
大型单中心回顾性病例系列研究。
英国伦敦的一级创伤中心。
2014年至2019年间接受手术治疗的骨骼成熟的不稳定型Lisfranc损伤患者的连续病例。
切开复位并使用DBP固定，不常规取出植入物。
最终随访时患者报告的结局指标。曼彻斯特-牛津足部问卷总结指数是主要结局指标。美国矫形足踝协会（AOFAS）中足评分、并发症和全因再手术率是次要结局指标。使用逻辑回归模型确定影响结局的危险因素。
纳入85例患者。平均随访40.8个月（24 - 72个月）。曼彻斯特-牛津足部问卷总结指数平均为27.0（标准差7.1），AOFAS评分平均为72.6（标准差11.6）。关节内骨折的存在与较差的结局相关，MOXFQ和AOFAS评分更差（均P < 0.001）。18例患者（21%）需要取出植入物，女性患者更有可能如此（比值比3.89，95%置信区间，1.27至12.0，P = 0.02）。8例患者（9%）需要二次关节融合术。
这是迄今为止报道的采用DBP固定治疗Lisfranc损伤的最大系列病例，也是唯一常规保留植入物的研究。中期结局与常规取出植入物的现有文献相当。关节内骨折的存在是不良预后指标。女性患者更有可能需要取出植入物。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
