Objective: To observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury.
Methods: Between March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score.
Results: The average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values ( P<0.05). There was no significant difference between the time points after operation ( P>0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] ( t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%.
Conclusion: The reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.
目的: 总结跖跗关节损伤中采用 Endobutton 钢板重建 Lisfranc 韧带的早期临床疗效。.
方法: 2015 年 3 月—2018 年 7 月，采用 Endobutton 钢板重建 Lisfranc 韧带治疗 18 例跖跗关节损伤患者。男 12 例，女 6 例；年龄 16～55 岁，平均 32.5 岁。致伤原因：交通事故伤 8 例，高处坠落伤 3 例，压砸伤 4 例，扭伤 3 例。Myerson 分型：A 型 10 例，B1 型 4 例，B2 型 2 例，C1 型 1 例，C2 型 1 例。受伤至手术时间 3～9 d，平均 4.9 d。术后定期行 X 线片复查，测量第 1、2 跖骨关节间隙距离；采用疼痛视觉模拟评分（VAS）评价疼痛缓解情况。末次随访时，测量并比较健、患侧足弓高度以评估跖跗关节复位情况，根据美国矫形足踝协会（AOFAS）评分评价足部功能。.
结果: 患者均获随访，随访时间 10～28 个月，平均 15.8 个月。术后切口均Ⅰ期愈合。X 线片复查示无螺钉松动、钢板断裂等并发症发生。术后 3 个月、内固定物取出前及末次随访时，第 1、2 跖骨关节间隙距离以及 VAS 评分与术前比较，差异均有统计学意义（ P<0.05）；术后各时间点间差异均无统计学意义（ P>0.05）。末次随访时，患侧足弓高度为（5.3±0.2）mm，与健侧（5.4±0.3）mm 比较，差异无统计学意义（ t=1.798， P=0.810）。根据 AOFAS 评分评价足部功能为（89.5±7.3）分；获优 12 例、良 4 例、可 2 例，优良率 88.9%。.
结论: 采用 Endobutton 钢板重建 Lisfranc 韧带，能较好地稳定跖跗关节，获得满意的早期足部功能。.
Keywords: Endobutton plate; Lisfranc ligament; foot function; ligament reconstruction; tarsometatarsal joint.