He Wenbao, Xia Jiang, Zhou Haichao, Li Zhendong, Zhao Youguang, Yang Yunfeng, Li Bing
Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Surg. 2022 Aug 19;9:984669. doi: 10.3389/fsurg.2022.984669. eCollection 2022.
To investigate the clinical efficacy of staged surgery for patients with closed Lisfranc injury and dislocation.
This study included 48 patients with acute closed Lisfranc injury and dislocation admitted between July 2016 and July 2021. The patients were divided into two groups. 23 patients in group A underwent staged surgeries included emergency reduction within 4-8 h after injury, and open reduction and internal fixation of Lisfranc injury and first tarsometatarsal joint fusion after the swelling had subsided. 25 patients in group B underwent open reduction and internal fixation as an elective procedure after the swelling had subsided. American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores and visual analog scale (VAS) scores were used for assessment at the final follow-up.
A total of 48 patients with closed Lisfranc injury and dislocation were included. The lengths of hospitalization were 11.52 ± 1.61 day and 19.80 ± 2.37 day in groups A and B, respectively. The total lengths of surgery were 67.34 ± 1.71 min and 104.36 ± 8.31 min in groups A and B, respectively. 48 patients completed the final follow-up (follow-up period range: 12-24 months, mean: 18 months). All fractures had healed at 12-18 weeks after surgery (mean: 14.6 weeks). At the 1-year postoperative follow-up, the AOFAS and VAS score was 86.87 ± 4.24 and 1.91 ± 0.78, respectively, during weight-bearing walking in group A patients and 71.72 ± 5.46 and 3.20 ± 1.17 in group B. By the end of the follow-up period, only 2 patients in group B had developed traumatic arthritis and no patients had joint re-dislocation or required secondary surgery.
Staged surgery for closed Lisfranc injury with dislocation reduced the incidence of perioperative complications and achieved good surgical outcomes while shortening the lengths of surgery and hospitalization.
探讨分期手术治疗闭合性Lisfranc损伤脱位患者的临床疗效。
本研究纳入2016年7月至2021年7月收治的48例急性闭合性Lisfranc损伤脱位患者。将患者分为两组。A组23例患者接受分期手术，包括伤后4 - 8小时内急诊复位，肿胀消退后行Lisfranc损伤切开复位内固定及第一跖跗关节融合术。B组25例患者在肿胀消退后择期行切开复位内固定术。末次随访时采用美国矫形足踝协会（AOFAS）中足评分和视觉模拟量表（VAS）评分进行评估。
共纳入48例闭合性Lisfranc损伤脱位患者。A组和B组的住院时间分别为11.52±1.61天和19.80±2.37天。A组和B组的手术总时长分别为67.34±1.71分钟和104.36±8.31分钟。48例患者完成末次随访（随访期范围：12 - 24个月，平均18个月）。所有骨折在术后12 - 18周愈合（平均14.6周）。术后1年随访时，A组患者负重行走时AOFAS评分和VAS评分分别为86.87±4.24和1.91±0.78，B组分别为71.72±5.46和3.20±1.17。随访期末，B组仅2例患者发生创伤性关节炎，无患者出现关节再脱位或需要二次手术。
闭合性Lisfranc损伤脱位分期手术降低了围手术期并发症的发生率，在缩短手术时长和住院时间的同时取得了良好的手术效果。
