切开复位内固定(ORIF)是治疗移位的Lisfranc损伤的流行方法。然而,即使是解剖复位和坚固的内固定,在某些严重脱位中,治疗效果不佳.这项研究的目的是比较ORIF和第一睑板(TMT)关节的原发性关节固定术(PA),以治疗Lisfranc损伤并伴有第一TMT关节脱位。
最终纳入了78例Lisfranc首次TMT关节脱位损伤,并进行了前瞻性分析,比较ORIF和PA的随机试验。他们分别为50名男性和女性,平均年龄为40.7岁,随机分为ORIF组和PA组。结果措施包括射线照片,美国骨科足踝协会(AOFAS)足中量表,脚和脚踝能力测量(FAAM)运动分量表,视觉模拟量表(VAS),和36项简式健康调查(SF-36)。分析并发症和翻修率。
40名患者接受了ORIF治疗,PA组38例。患者随访37.8(范围,24-48)个月。在最后的后续行动中,AOFAS中足平均评分(P<0.01),FAAM运动分量表(P<0.01),躯体功能评分(P<0.05),ORIF治疗后SF-36疼痛评分明显低于PA组(P<0.05)。ORIF组平均VAS评分较高(P<0.01)。在ORIF组中,10例观察到第一个TMT关节再脱位,13名患者中足疼痛。PA组未发现再脱位和硬件故障。
对于第一次TMT脱位的Lisfranc损伤,第一个TMT关节的PA提供了比ORIF更好的中期结果。对于脱臼的第一射线损伤,PA可以避免可能的并发症和翻修。
Open reduction and internal fixation (ORIF) is a popular method for treatment of displaced Lisfranc injuries. However, even with anatomic reduction and solid internal fixation, treatment does not provide good outcomes in certain severe dislocations. The purpose of this
study was to compare ORIF and primary arthrodesis (PA) of the first tarsometatarsal (TMT) joint for Lisfranc injuries with the first TMT joint dislocation.
Seventy-eight Lisfranc injuries with first TMT joint dislocation were finally enrolled and analyzed in a prospective, randomized
trial comparing ORIF and PA. They were 50 males and females with a mean age of 40.7 years and randomized to ORIF group and PA group. Outcome measures included radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, Foot and Ankle Ability Measure (FAAM) Sports subscale, visual analog scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Complications and revision rate were also analyzed.
Forty patients were treated by ORIF, while PA group includes 38 cases. Patients were followed up for 37.8(range, 24-48) months. At final follow-up, the mean AOFAS midfoot score (P < 0.01), the FAAM Sports subscale (P < 0.01), the physical function score (P < 0.05), and the Bodily Pain score of SF-36 (P < 0.05) after ORIF treatment were significantly lower than PA group. The mean VAS score in ORIF group was higher (P < 0.01). In ORIF group, redislocation of the first TMT joint was observed in ten cases, and thirteen patients had pain in midfoot. No redislocation and no hardware failure were identified in PA group.
PA of the first TMT joint provided a better medium-term outcome than ORIF for Lisfranc injuries with the first TMT dislocation. Possible complications and revision could be avoided by PA for dislocated first ray injuries.