经关节螺钉、背侧钢板及两者联合固定治疗Lisfranc骨折脱位的效果
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摘要
目的:探讨经关节螺钉、背侧钢板及两者联合固定治疗Lisfranc骨折脱位的疗效及预后。方法:将2015年6月-2017年6月在我院接受治疗的120例Lisfranc骨折脱位患者根据治疗方式不同分组:A组(28例),给予经关节螺钉固定治疗;B组(34例),给予背侧钢板固定治疗;C组(58例),给予经关节螺钉与背侧钢板联合治疗。对3组患者治疗前后踝-后足评分(AOFAS)、创伤性关节炎发生情况、解剖复位情况以及并发症率进行综合评价。结果:C组治疗后AOFAS评分显著低于A组、B组(P<0.05);C组创伤性关节炎分级、解剖复位优良率均显著高于A组、B组(P<0.05);C组术后并发症率高于其他两组(P<0.05)。结论:经关节螺钉、背侧钢板治疗Lisfranc骨折脱位早期预后相近,联合治疗存在较多并发症,而良好解剖复位是提升预后的重要因素。
Objective:To explore the curative effect and prognosis of Lisfranc fracture and dislocation by joint screw,dorsal plate and both.Methods:A total of 120 cases of Lisfranc fracture and dislocation in our hospital from June 2015 to June 2017 were selected as the research object.According to different treatments,patients were divided into 3 groups:group A with 28 cases,treated with joint screw fixation,group B with 34 cases,given dorsal plate fixation treatment,and group C with 58 cases,treated by the joint screw combination therapy with dorsal plates.Ankle-hind score(AOFAS)before and after treatment,traumatic arthritis,anatomical reduction and complications rate in these three groups were comprehensively evaluated.Results:The AOFAS score of group C was significantly lower than those of group A and group B(P<0.05).Grade of traumatic arthritis and the excellent and good rate of anatomical reduction in group C were significantly higher than those of group A and group B(P<0.05).However,postoperative complications rate of group C was higher than the other two groups(P<0.05).Conclusion:The early progno-sis is similar in the treatment of Lisfranc fracture with joint screw and dorsal plate,and there are more complications in the combined treatment,and the important factor for improving prognosis is good anatomical reduction.
Objective:To explore the curative effect and prognosis of Lisfranc fracture and dislocation by joint screw,dorsal plate and both.Methods:A total of 120 cases of Lisfranc fracture and dislocation in our hospital from June 2015 to June 2017 were selected as the research object.According to different treatments,patients were divided into 3 groups:group A with 28 cases,treated with joint screw fixation,group B with 34 cases,given dorsal plate fixation treatment,and group C with 58 cases,treated by the joint screw combination therapy with dorsal plates.Ankle-hind score(AOFAS)before and after treatment,traumatic arthritis,anatomical reduction and complications rate in these three groups were comprehensively evaluated.Results:The AOFAS score of group C was significantly lower than those of group A and group B(P<0.05).Grade of traumatic arthritis and the excellent and good rate of anatomical reduction in group C were significantly higher than those of group A and group B(P<0.05).However,postoperative complications rate of group C was higher than the other two groups(P<0.05).Conclusion:The early progno-sis is similar in the treatment of Lisfranc fracture with joint screw and dorsal plate,and there are more complications in the combined treatment,and the important factor for improving prognosis is good anatomical reduction.
引文
[1]颜翼,邱志龙,梁培雄,等.AO空心螺钉联合克氏针三柱固定治疗Myerson C型Lisfranc关节损伤[J].中华创伤骨科杂志,2015,17(12):1 093-1 095.Yan Y,Qiu ZL,Liang PX,et al.AO hollow screws combined with Kirschner pin three column fixation for the treatment of Myerson C Lisfranc joint injury[J].Chinese Journal of Orthopaedic Trauma,2015,17(12):1 093-1 095.
[2]孙建筑,隆权利,赵金枝.无头空心螺钉联合腓骨远端解剖型钢板对三踝骨折患者的近期疗效及预后观察[J].山西医药杂志,2016,45(10):1 203-1 206.Sun JZ,Long QL,Zhao JZ.Head free hollow screw combined with distal fibula anatomic plate for three ankle fractures in the near future and prognosis[J].Shanxi Journal of Medicine,2016,45(10):1 203-1 206.
[3]杨英果,戈兵,朱冬承,等.Ⅰ期切开复位微“T”形锁定钢板联合Herbert螺钉与克氏针固定治疗Myerson C型Lisfranc关节损伤11例[J].中华创伤杂志,2017,33(9):145-146.Yang YG,Ge B,Zhu DC,et al.Phase I open reduction,micro"T"locking plate combined with Herbert screw and Kirschner pin fixation for Myerson C Lisfranc joint injury in 11cases[J].Chinese Journal of Trauma,2017,33(9):145-146.
[4] Park HW,Yi HS.Analysis of clinical outcome and prognosis for lisfranc joint fracture and dislocation according to the injury mechanism and treatment method[J].Biotechnology&Bioengineering,2014,18(3):124.
[5]李贝,谭坚毅,曾志彬,等.微型钛板联合空心钉治疗Myerson B-C型Lisfranc损伤的临床应用[J].实用骨科杂志,2015,21(7):600-603.Li B,Tan JY,Ceng ZB,et al.Clinical application of micro titanium plate combined with hollow nail in the treatment of Myerson B-C Lisfranc damage[J].Journal of Practical Orthopaedics,2015,21(7):600-603.
[6]李雪松,邸薇宁,李景银,等.微型锁定加压钢板结合拉力螺钉及克氏针治疗A型Lisfranc损伤27例[J].中国中医骨伤科杂志,2017,21(6):68-70.Li XS,Di WN,Li JY,et al.Application of minitype locking compression plate combined with pull screw and Kirschner needle for type A Lisfranc injury in 27cases[J].Chinese Journal of Traditional Medical Traumatology&Orthopedics,2017,21(6):68-70.
[7]杨宇,刘欣伟,凯赛尔江·艾合买提,等.应用Acutrak螺钉与空心螺钉治疗Lisfranc关节损伤的临床分析[J].实用骨科杂志,2015,16(10):891-893.Yang Y,Liu XW,Kesselyan A,et al.Comparison of Acutrak screw and Cannulated screw in surgical treatment of Lisfranc injury[J].Journal of Practical Orthopaedics,2015,16(10):891-893.
[8]傅跃龙,王秀会,朱汉光,等.Nunley分型在低能量Lisfranc损伤治疗中的意义[J].实用骨科杂志,2016,19(2):120-122.Fu YL,Wang XH,Zhu HG,et al.Clinical value of Nunley classification in the treatment for low energy Lisfranc injury[J].Journal of Practical Orthopaedics,2016,19(2):120-122.
[9]邓志刚,张圣浛,刘星.续骨活血汤配合解剖复位与空心螺钉内固定治疗股骨颈骨折的临床研究[J].国际中医中药杂志,2015,21(7):613-616.Deng ZG,Zhang SH,Liu X.Xugu-Huoxue decoction combined with anatomical reduction and internal fixation with cannulated screws for femoral neck fractures[J].International Journal of Traditional Chinese Medicine,2015,21(7):613-616.
[10]孙绳亮,司丽娜.经关节螺钉、背侧钢板及两者联合固定治疗Lisfranc骨折脱位的预后研究[J].中国现代医学杂志,2016,26(19):104-109.Sun SL,Si LN.Outcomes of Lisfranc fracture dislocation treated by transarticular screw,dorsal bridging plates and their combination[J].China Journal of Modern Medicine,2016,26(19):104-109.
[2]孙建筑,隆权利,赵金枝.无头空心螺钉联合腓骨远端解剖型钢板对三踝骨折患者的近期疗效及预后观察[J].山西医药杂志,2016,45(10):1 203-1 206.Sun JZ,Long QL,Zhao JZ.Head free hollow screw combined with distal fibula anatomic plate for three ankle fractures in the near future and prognosis[J].Shanxi Journal of Medicine,2016,45(10):1 203-1 206.
[3]杨英果,戈兵,朱冬承,等.Ⅰ期切开复位微“T”形锁定钢板联合Herbert螺钉与克氏针固定治疗Myerson C型Lisfranc关节损伤11例[J].中华创伤杂志,2017,33(9):145-146.Yang YG,Ge B,Zhu DC,et al.Phase I open reduction,micro"T"locking plate combined with Herbert screw and Kirschner pin fixation for Myerson C Lisfranc joint injury in 11cases[J].Chinese Journal of Trauma,2017,33(9):145-146.
[4] Park HW,Yi HS.Analysis of clinical outcome and prognosis for lisfranc joint fracture and dislocation according to the injury mechanism and treatment method[J].Biotechnology&Bioengineering,2014,18(3):124.
[5]李贝,谭坚毅,曾志彬,等.微型钛板联合空心钉治疗Myerson B-C型Lisfranc损伤的临床应用[J].实用骨科杂志,2015,21(7):600-603.Li B,Tan JY,Ceng ZB,et al.Clinical application of micro titanium plate combined with hollow nail in the treatment of Myerson B-C Lisfranc damage[J].Journal of Practical Orthopaedics,2015,21(7):600-603.
[6]李雪松,邸薇宁,李景银,等.微型锁定加压钢板结合拉力螺钉及克氏针治疗A型Lisfranc损伤27例[J].中国中医骨伤科杂志,2017,21(6):68-70.Li XS,Di WN,Li JY,et al.Application of minitype locking compression plate combined with pull screw and Kirschner needle for type A Lisfranc injury in 27cases[J].Chinese Journal of Traditional Medical Traumatology&Orthopedics,2017,21(6):68-70.
[7]杨宇,刘欣伟,凯赛尔江·艾合买提,等.应用Acutrak螺钉与空心螺钉治疗Lisfranc关节损伤的临床分析[J].实用骨科杂志,2015,16(10):891-893.Yang Y,Liu XW,Kesselyan A,et al.Comparison of Acutrak screw and Cannulated screw in surgical treatment of Lisfranc injury[J].Journal of Practical Orthopaedics,2015,16(10):891-893.
[8]傅跃龙,王秀会,朱汉光,等.Nunley分型在低能量Lisfranc损伤治疗中的意义[J].实用骨科杂志,2016,19(2):120-122.Fu YL,Wang XH,Zhu HG,et al.Clinical value of Nunley classification in the treatment for low energy Lisfranc injury[J].Journal of Practical Orthopaedics,2016,19(2):120-122.
[9]邓志刚,张圣浛,刘星.续骨活血汤配合解剖复位与空心螺钉内固定治疗股骨颈骨折的临床研究[J].国际中医中药杂志,2015,21(7):613-616.Deng ZG,Zhang SH,Liu X.Xugu-Huoxue decoction combined with anatomical reduction and internal fixation with cannulated screws for femoral neck fractures[J].International Journal of Traditional Chinese Medicine,2015,21(7):613-616.
[10]孙绳亮,司丽娜.经关节螺钉、背侧钢板及两者联合固定治疗Lisfranc骨折脱位的预后研究[J].中国现代医学杂志,2016,26(19):104-109.Sun SL,Si LN.Outcomes of Lisfranc fracture dislocation treated by transarticular screw,dorsal bridging plates and their combination[J].China Journal of Modern Medicine,2016,26(19):104-109.