Engelmann Esmee W M, Halm Jens A, Schepers Tim
Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Amsterdam Movement Sciences, Amsterdam University Medical Centers, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):49. doi: 10.1007/s00068-024-02747-w.
The aim was to assess the long-term functional outcome and quality of life after staged surgical treatment of complex Lisfranc and Chopart injuries in a patient cohort, and to perform a systematic review of the literature.
A retrospective cohort of all trauma patients with complex Lisfranc and/or Chopart injuries treated at our level 1 trauma center between July 1, 2010, and July 1, 2020 with ≥ 3 years follow-up was analyzed in terms of management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, AOFAS and Foot Function Index, FFI). A systematic review of the literature (according to PRISMA 2020 guidelines) was performed of studies published between January 2000 to April 2024. Inclusion criteria were acute, complex Lisfranc and/or Chopart injury, staged treatment, age ≥ 17 years, patient-reported outcome measures and ≥ 1 year follow-up.
Fifteen patients with a median follow-up of 6.6 years (interquartile range 4) were included. First stage treatment involved temporary K-wire fixation (n = 11), debridement (open fractures, n = 4), external fixation (n = 4) and decompression fasciotomy (n = 3). Second stage included primary arthrodesis (n = 4), open reduction and internal fixation (n = 7) or external fixation (n = 1). The median number of surgeries was 3 (2-13). Infection was seen in 5/15 patients; 7/11 patients underwent secondary arthrodesis and one patient underwent amputation due to chronic pain. Overall AOFAS was fair (54.5) and five patients had poor outcome (AOFAS < 49). Three full-length articles were included in the systematic review, reporting fair to good outcome. Risk of bias was serious and certainty of evidence very low.
Surgical management of complex Lisfranc and Chopart injuries is challenging, functional outcome was poor to fair, postoperative complication rates are high, and secondary salvage arthrodesis was required in two thirds of ORIF patients.
IV.
评估一组患者在接受分期手术治疗复杂Lisfranc和Chopart损伤后的长期功能结局和生活质量，并对相关文献进行系统综述。
对2010年7月1日至2020年7月1日期间在我们的一级创伤中心接受治疗且随访时间≥3年的所有复杂Lisfranc和/或Chopart损伤的创伤患者进行回顾性队列分析，内容包括治疗方法、并发症以及患者报告的结局（美国矫形足踝协会中足评分、AOFAS和足功能指数、FFI）。根据PRISMA 2020指南对2000年1月至2024年4月发表的研究进行文献系统综述。纳入标准为急性、复杂Lisfranc和/或Chopart损伤、分期治疗、年龄≥17岁、患者报告的结局指标以及随访时间≥1年。
纳入15例患者，中位随访时间为6.6年（四分位间距为4年）。第一阶段治疗包括临时克氏针固定（n = 11）、清创术（开放性骨折，n = 4）、外固定（n = 4）和减压筋膜切开术（n = 3）。第二阶段包括一期关节融合术（n = 4）、切开复位内固定术（n = 7）或外固定术（n = 1）。手术次数中位数为3次（2 - 13次）。15例患者中有5例发生感染；11例患者中有7例行二期关节融合术，1例患者因慢性疼痛接受截肢手术。总体AOFAS评分为中等（54.5），5例患者结局较差（AOFAS < 49）。系统综述纳入3篇全文文章，报告结局为中等至良好。偏倚风险严重，证据确定性非常低。
复杂Lisfranc和Chopart损伤的手术治疗具有挑战性，功能结局较差至中等，术后并发症发生率高，三分之二的切开复位内固定术患者需要二期挽救性关节融合术。
IV级。
