| Objective: Comparative analysis for the curative effect was performed betweenthe treatment of Lisfranc injury with the hollow screw and miniature steel plate internalfixation.Methods: Reviewed the clinical records of40patients with Lisfranc joint injuryin our hospital，they were treated with hollow screw internal fixation(hereinafterreferred to as A group) and miniature steel plate internal fixation (hereinafter referred toas B group),23cases in group A,17cases in group B. male27cases and female13cases. age range from17years old to68years old,46years old on average. causes：13cases for traffic accident injury,8cases for falling injury,9cases for crashing,6patients with crushing,4cases for sprain.21cases of closed injury and19cases of openinjury.21cases of high-energy injury,19cases of low-energy injury.all classified byhardcastle: type A (shift)20cases; type B (partial shift)：B1(4cases), B2(9cases);type C (separation)：C1(4cases), C2(3cases). pure lisfranc joint dislocation,16cases.24cases with metatarsus, wedge or cuboid bone fractures. in which, group A,15cases,group B,9cases.7cases with diabetes,3cases with craniocerebral injury，5cases withtibial fractures,4cases with thoracic or lumbar vertebral body fractures,2patients withpelvic ring fractures.syndrome in1case occurred bone fascia room, through the timelyincision decompression VSD cover, screw fixation surgery in7to10days later. all ofthe patients with injury for foot swelling, physical inactivity as the main symptoms,confirmed by X-ray, CT, etc, there are different degrees of Lisfranc injury, laboratoryinspection did not see such as surgery contraindications,1-10days after injury, anaverage5.7days do surgery. postoperative and follow-up by applying the method ofvisual analog pain score (VAS) and the american orthopaedic foot and ankle societyscore standards (AOFAS) to efficacy evaluation of group A and group B, and observedtwo groups of postoperative complications and combined fracture occurrence of fracture healing time.Results: All patients were followed up for12to18months, an average of10.4months. postoperative X ray film and CT scan in both groups were anatomicalrepositioning, joint para, on line relationship is good, the longitudinal arch andtransverse arch form basically returned to normal, no dorsal metatarsal shift; butlong-term follow-up found that some patients of group A joint para, on line relationshipcompared with postoperative week, complications, and satisfaction when arch form aswell as postoperative weekVAS score: group A (7.27±0.40) points preoperatively, postoperatively for2weeks(2.59±0.64) points, after8weeks (1.87±0.49) points; group B (7.15±0.17) pointspreoperatively, postoperatively for2weeks (2.14±0.70) points, after8weeks (0.75±0.13) points.difference have statistical significance at postoperatively for8weeks.AOFAS score: group A: optimal:3cases, benign:7cases, medium:11cases, poor:2cases, fine rate was only43.4%. group B: optimal:9cases, benign:5cases, medium:2cases, poor:1case, fine rate was82.3%.2group was statistically significant;Postoperative group A’s beard needle infection in2cases,1case of patientsaffected part skin necrosis, gram needle loose1case,2cases of patients with foot andankle joint stiffness,2cases with screw breakage and arch flattens,4cases withtraumatic arthritis.2cases in group B patients suffering from foot pain symptoms, andthe needle was1case appeared loose, part1foot dorsal skin necrosis, no othercomplications occurred.2group’s complications occurred rate was statisticallysignificant;With metatarsal, wedge or cuboid bone fracture of the15patients in group A of thefracture healing time of16～28(18.0±0.4)weeks,9cases of group B patients withfracture healing time of15～26(17.6±0.7)weeks; No difference between the2groups.Conclusion: Hollow screw for lisfranc joint injury patients, open reduction andinternal fixation operation although relatively simple, but to maintain long-term stabilityis not better than group B, the needle was traumatic sex arthritis, is loose, screwbreakage risk of such complications as compared with group B, and the forwardcurative effect is worse than group B;Miniature steel plate internal fixation to accurately assess under direct jointstability, coagulation clot in clear joints and hinder the reset of the broken bone and softtissue within the card into the joint, to reset the anatomy of the fracture, dislocation,returned to normal joint structure, repair damaged tissue, at the same time also look under the plate is placed in a more accurate fixed position, fixed stronger, especially torequire strong internal fixation of the medial middle column and column is well suited,and to avoid the further damage of damaged articular surface, reduce or avoidtraumatic sex arthritisthe〠foot-arch collapse, such as complications, promote injuryrecovery as soon as possible, to improve patients quality of life，it is a really effectivetreatment method. |
