Wilhelmina Maria Engelmann Esmee, Halm Jens Anthony, Schepers Tim
Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.
Foot Ankle Int. 2025 Jan;46(1):46-53. doi: 10.1177/10711007241288853. Epub 2024 Nov 6.
The choice between primary arthrodesis (PA) and open reduction and internal fixation (ORIF) for acute Lisfranc injuries remains contentious. Apart from primary treatment, arthrodesis is often used for treating chronic Lisfranc injuries, including patients in whom initial ORIF or nonoperative treatment failed. The aim of this study was to compare PA and secondary arthrodesis (SA) in terms of complications and functional outcome.
A retrospective cohort study was conducted on trauma patients with Lisfranc injuries treated at a level 1 trauma center between July 1, 2010, and July 1, 2020. Selected patients were evaluated at the outpatient clinic and received a survey. Demographics, injury characteristics, management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, Foot Function Index) were analyzed.
Twenty-nine of 37 potential patients (78.4%; PA n = 11, SA n = 18) completed the survey with a median follow-up of 7.1 (PA) to 9.3 (SA) years ( = .01). The majority were female (n = 18, 62.1%); the mean age of PA patients was 57.1 years (SD 14.2) compared with 43.5 years (SD 17.1) in SA patients ( = .04). In the PA group, there was no infection, 100% union, and implants were removed in 5 of 11 patients. In the SA group, 11.1% (n = 2) developed infection, malunion rate was 11.1%, implants were removed in 33.3% (n = 6), and 22.2% required revision surgery. AOFAS was "good" in PA (77.7, SD 17.3) compared with rated "fair" in SA (67.1, SD 21.3, = .19). FFI was better in PA (26.0, SD 26.2) than SA (37.6, SD 30.8, = .32), which exceeded the minimally important clinical difference.
Although this study was limited by sample size, the overall results suggest equivalent functional outcome, pain and treatment satisfaction in primary arthrodesis compared with secondary arthrodesis patients for treatment of Lisfranc injury.
对于急性Lisfranc损伤，一期关节融合术（PA）与切开复位内固定术（ORIF）之间的选择仍存在争议。除了初始治疗外，关节融合术还常用于治疗慢性Lisfranc损伤，包括初始ORIF或非手术治疗失败的患者。本研究的目的是比较PA和二期关节融合术（SA）在并发症和功能结果方面的差异。
对2010年7月1日至2020年7月1日期间在一级创伤中心接受治疗的Lisfranc损伤创伤患者进行了一项回顾性队列研究。入选患者在门诊接受评估并接受调查。分析了人口统计学、损伤特征、治疗方法、并发症以及患者报告的结果（美国矫形足踝协会中足评分、足部功能指数）。
37名潜在患者中的29名（78.4%；PA组11例，SA组18例）完成了调查，中位随访时间为PA组7.1年至SA组9.3年（P = 0.01）。大多数为女性（18例，62.1%）；PA组患者的平均年龄为57.1岁（标准差14.2），而SA组患者为43.5岁（标准差17.1）（P = 0.04）。在PA组中，无感染发生，愈合率为100%，11例患者中有5例取出了植入物。在SA组中，11.1%（2例）发生感染，畸形愈合率为11.1%，33.3%（6例）取出了植入物，22.2%需要翻修手术。PA组的美国矫形足踝协会中足评分为“良好”（77.7，标准差17.3）；相比之下，SA组评分为“一般”（67.1，标准差21.3，P = 0.19）。PA组的足部功能指数优于SA组（26.0，标准差26.2对37.6，标准差30.8，P = 0.32），超过了最小重要临床差异。
尽管本研究受样本量限制，但总体结果表明，在治疗Lisfranc损伤方面，与二期关节融合术患者相比，一期关节融合术患者的功能结果、疼痛和治疗满意度相当。
