Herbert钉与皮质骨螺钉治疗Lisfranc损伤对比研究

许京伟 王静 周洪杰 李越

[关键词] 跖跗关节损伤;Herbert钉;皮质骨螺钉;内固定

[中图分类号] R683.42          [文献标识码] B          [文章编号] 1673-9701（2021）29-0100-04

Comparative study of Herbert screw and cortical screw in treatment of Lisfranc injury

XU Jingwei1   WANG Jing2   ZHOU Hongjie3   LI Yue1

1.No.1 of Department of Orthopedics and Traumatology， Rizhao Hospital of Traditional Chinese Medicine in Shandong Province， Rizhao   276800， China; 2.Department of Brain Diseases， Rizhao Hospital of Traditional Chinese Medicine in Shandong Province， Rizhao   276800， China; 3.No.4 of Department of Orthopedics and Traumatology， Rizhao Hospital of Traditional Chinese Medicine in Shandong Province， Rizhao   276800， China

[Abstract] Objective To investigate the effect of Herbert screw on the application and functional recovery of Lisfranc injury patients. Methods A total of 44 Lisfranc injury patients admitted to our hospital from December 2016 to December 2019 were selected and randomly divided into two groups， with 22 cases in each group. The observation group received Herbert screw fixation. The control group received ordinary cortical bone screw fixation. After the incision healed， the two groups of patients were treated with traditional Chinese medicine Huoxue Zhitong San to improve their symptoms. The postoperative AOFAS score， VAS score and excellent and good rate were compared between the two groups. Results After systemic treatment， the AOFAS score at 6 months after surgery（91.43±3.55）points in the observation group was higher than the score of the control group （75.36±3.46）points， and the difference was statistically significant （P<0.05）. The VAS score （1.92±0.65）points of the observation group was lower than that of the control group （2.89±0.71）points at 6 months after the operation， and the difference was statistically significant （P<0.05）. The excellent and good function rate at 6 months after the operation was 90.91%， higher than that of the control group （63.64%）， which was statistically significant （P<0.05）. Conclusion Compared with cortical screw fixation， Herbert screw has more effective results in improving the postoperative function of patients with Lisfranc injury.

[Key words] Metatarsotarsus joint injury; Herbert screw; Cortical screw; Internal fixation

Lisfranc損伤（法国人Lisfranc发现得名）指的是跖跗关节及其复合体的骨折脱位等损伤，因为其发病率较低及影像学的阳性率低，既往容易被忽视，因治疗过失引起疼痛、畸形愈合等并发症[1]，甚至造成残疾，给患者带来痛苦，随着医学认知水平提高及科技水平的发展，尤其是MRI、超声[2]等诊断技术的成熟，对Lisfranc损伤的认知日趋完善，诊治手段日趋成熟，采用积极的手术治疗干预，恢复关节的对位关系，对于关节及其周围韧带、纤维组织的修补重建，后期往往能有良好的治疗效果。对于跖跗关节脱位的治疗方式有切开内固定（Open reduction internal fixation，ORIF）、原位关节的融合多种术式[3]，固定方式目前有皮质骨螺钉、空心钉、微型钛钢板及Herbert钉多种方法，但对具体某种方法的优势及缺点没有明确的统计分析，本研究对ORIF治疗Lisfranc损伤中应用普通螺钉及Herbert螺钉的44例患者分析研究，现报道如下。

1 资料与方法

1.1 一般资料

选择2016年12月至2019年12月我院收治的Lisfranc损伤患者44例，受伤原因：车祸导致的交通外伤12例，硬物等直接暴力砸伤20例，摔伤、扭伤等运动性损伤12例。纳入标准：①完全经我院诊治的患者;②年龄15～65岁;③单纯足部损伤;④配合随访时间≥12个月。排除标准：①合并严重心脑血管、精神疾病等其他基础疾病导致无法行走配合者;②合并血管神经、足踝或其他部位损伤影响功能评分者;③依从性较差、无法跟踪随访及中途因故退出者。……