Lisfranc损伤开放复位内固定术后是否需要常规移除植入物？比较常规取出和按需取出的功能效果：一项多中心研究

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-03-04 DOI:10.1016/j.injury.2025.112240

Satoshi Muto , Yasuhiko Takegami , Hiroaki Nakashima , Kenichi Mishima , Hiroaki Kumagai , Shiro Imagama

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引用次数: 0

摘要

lisfranc关节损伤是破坏足部稳定性和功能的严重原因，通常需要手术干预，如切开复位和内固定（ORIF）。愈合后常规移除种植体的必要性仍然存在争议。本研究旨在比较Lisfranc骨折脱位患者在ORIF术后接受常规、按需或不植入物移除的患者的功能恢复和术后并发症。材料与方法本研究是一项多中心回顾性研究，对188例使用ORIF治疗Lisfranc骨折脱位的患者进行分析。患者分为常规切除（RR）、按需切除（ODR）和不切除（NR）三组。在最后随访时，使用美国骨科足踝学会（AOFAS）中足评分评估功能结果。并发症分为种植体相关并发症和拔除后并发症。比较三组患者AOFAS中足评分及并发症发生率。结果末次随访时，RR组的AOFAS中位脚评分为92分（IQR 83.00-95.00）， ODR组为95分（IQR 85.00-95.00）， NR组为95分（IQR 82.00-95.00），三组间差异无统计学意义(p >；0.05)。尽管ODR组的刺激发生率（42.9%）明显高于RR组（24.4%）和NR组（11.9%）（p = 0.013），但两组间的种植体相关并发症具有可比性。RR组出现2例拔除后并发症，其中1例矫形丧失需要再次手术。结论与选择性拔除或保留相比，常规拔除种植体在功能恢复或并发症发生率方面没有更好的结果。种植体保留或选择性移除根据个人需要，最大限度地减少并发症和优化患者的结果。

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Is routine implant removal necessary after open reduction internal fixation of Lisfranc injuries? Comparing functional outcomes of routine and on-demand removal: A multicenter study

Introduction

Lisfranc joint injuries are a severe cause of disruption of foot stability and function, often requiring surgical intervention such as open reduction and internal fixation (ORIF). The necessity of routine implant removal after healing remains controversial. This study aimed to compare functional recovery and postoperative complications among patients undergoing routine, on-demand, or no implant removal following ORIF for Lisfranc fracture-dislocations.

Materials and Methods

This multicenter retrospective study analyzed 188 patients treated with ORIF for Lisfranc fracture-dislocations. Patients were divided into three groups: routine removal (RR), on-demand removal (ODR), and no removal (NR). Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at the final follow-up. Complications were categorized as implant-related or post-removal. AOFAS midfoot scores and complication rates were compared between the three groups.

Results

The median AOFAS midfoot scores at the final follow-up were 92 (IQR 83.00–95.00) in the RR group, 95 (IQR 85.00–95.00) in the ODR group, and 95 (IQR 82.00–95.00) in the NR group, with no significant differences among the three groups (p > 0.05). Implant-related complications were comparable across the groups, although irritation was significantly more frequent in the ODR group (42.9 %) than in the RR (24.4 %) and NR (11.9 %) groups (p = 0.013). Post-removal complications occurred in two cases in the RR group, including one case of loss of correction requiring reoperation.

Conclusion

Routine implant removal did not show superior outcomes in functional recovery or complication rates compared to selective removal or retention. Implant retention or selective removal based on individual needs minimizes complications and optimizes patient outcomes.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.