Herbosa Christopher G, Esper Garrett W, Nwakoby Ekenedilichukwu V, Leucht Philipp, Konda Sanjit R, Tejwani Nirmal C, Egol Kenneth A
Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
J Foot Ankle Surg. 2023 Sep-Oct;62(5):768-773. doi: 10.1053/j.jfas.2023.03.006. Epub 2023 Mar 25.
This study compares outcomes of patients with Lisfranc injuries treated with screw only fixation constructs to those treated with dorsal plate and screw constructs. Seventy patients who underwent surgical treatment for acute Lisfranc injury without arthrodesis and minimum 6-month (mean >1-year) follow-up were identified. Demographics, surgical information, and radiographic imaging were reviewed. Cost data were compared. The primary outcome measure was the American Orthopedic Foot and Ankle Surgery (AOFAS) midfoot score. Univariate analysis through independent sample t tests, Mann-Whitney U, and chi-squared compared the populations. Twenty-three (33%) patients were treated with plate constructs and 47 (67%) with screw only fixation. The plate group was older (49 ± 18 vs 40 ± 16 years, p = .029). More screw constructs treated isolated medial column injuries compared to plate constructs (92% vs 65%, p = .006). At latest follow-up (mean 14 ± 13 months), all tarsometatarsal joints were aligned. There was no difference in AOFAS midfoot scores. Plate patients experienced longer operations (131 ± 70 vs 75 ± 31 minutes, p < .001) and tourniquet time (101 ± 41 vs 69 ± 25 minutes, p = .001). Plate constructs were more expensive than screw ($2.3X ± $2.3X vs $X ± $0.4X, p < .001) ($X is the mean cost of screws alone). Plate patients had a higher incidence of wound complications (13% vs 0%, p = .012). Treatment of Lisfranc fracture dislocation injuries with screws only demonstrated a higher value procedure as similar outcomes were found amidst lower implant costs. Screw only fixation required a shorter operative and tourniquet time with less frequent wound complications. Screw only fixations proved mechanically sound enough to achieve goals of repair without inferior outcomes.
本研究比较了仅采用螺钉固定结构治疗的Lisfranc损伤患者与采用背侧板和螺钉结构治疗的患者的治疗结果。确定了70例接受急性Lisfranc损伤手术治疗且未进行关节融合术并至少随访6个月（平均>1年）的患者。回顾了人口统计学、手术信息和影像学资料。比较了成本数据。主要结局指标是美国矫形足踝外科（AOFAS）中足评分。通过独立样本t检验、Mann-Whitney U检验和卡方检验进行单因素分析以比较两组人群。23例（33%）患者采用钢板结构治疗，47例（67%）仅采用螺钉固定。钢板组患者年龄更大（49±18岁 vs 40±16岁，p = 0.029）。与钢板结构相比，更多的螺钉结构用于治疗孤立的内侧柱损伤（92% vs 65%，p = 0.006）。在最近一次随访时（平均14±13个月），所有跗跖关节均对线良好。AOFAS中足评分无差异。采用钢板治疗的患者手术时间更长（131±70分钟 vs 75±31分钟，p < 0.001），止血带使用时间也更长（101±41分钟 vs 69±25分钟，p = 0.001）。钢板结构比螺钉更昂贵（2.3X±2.3X美元 vs X±0.4X美元，p < 0.001）（X为仅螺钉的平均成本）。采用钢板治疗的患者伤口并发症发生率更高（13% vs 0%，p = 0.012）。仅用螺钉治疗Lisfranc骨折脱位损伤显示出更高的性价比，因为在较低的植入成本下能获得相似的治疗结果。仅用螺钉固定所需的手术和止血带使用时间更短，伤口并发症更少。仅用螺钉固定在力学上足够稳固，能够实现修复目标且不会导致较差的治疗结果。
