Dorsal Plate Combined With Ligament Reconstruction In The Treatment Of Myerson B And C Type Lisfranc Complex Injuries

Objective: In this study it aims to investigate the clinical effect of dorsal plate combined with ligament reconstruction in the treatment of Myerson B and C type Lisfranc complex injuries.For patients with Myerson B and C type Lisfranc complex injuries,in addition to dorsal plate being used for transarticular fixation reduction of the fracture,partial gracilis tendon reconstruction was applied to repair the ruptured Lisfranc ligament and early movement was allowed under the protection of internal fixation.After removal of internal fixation the transplanted ligaments continued to provide elastic fixation.Lisfranc complex injury gradually attracted more and more attention from orthopedic doctors due to its high rate of missed diagnosis and severe post-traumatic complications.In the traditional treatment of Lisfranc complex injury,doctors often paid attention to the reduction of fracture and the recovery of the anatomical position of the middle foot,while neglected the reconstruction of the Lisfranc ligament.75% of patients treated with Open Reduction and Internal Fixation(ORIF)gradually lost the corrective function with the removal of internal fixation.Degenerative changes of Lisfranc joint displacement inevitably occurred.Anatomical reduction is considered to be the guarantee of recovery after Lisfranc injury.However,the loss of reduction after the removal of internal fixation has always been a difficult problem for clinicians.The significance for this study is to promote tendon bone healing + restoration of anatomical structure to be achieved with reconstruction of Lisfranc ligament under supporting and protection of internal fixation and to investigate the clinical effect of dorsal plate combined with ligament reconstruction in the treatment of Lisfranc complex injury,which provided a new idea for the treatment of Lisfranc complex injury.Method: 36 cases of Myerson type B and C Lisfranc complex injury treated in Affiliated Hospital of Hebei University from February 2015 to June 2019 were analyzed and divided into observation group and control group.18 cases(male: 12 cases;female: 6 cases)in the observation group were treated with dorsal plate combined with Lisfranc ligament reconstruction.18 cases(male: 10 cases;female: 8 cases)in the control group were treated with dorsal plate.Follow-up was conducted for 16-24 months,(19.36±2.642).Comparisons were made as following: 1.Comparison between control group and observation group in VAS score before surgery and operation time.2.Comparisons between control group and observation group in VAS score,AOFAS score and excellent rate after weight-bearing activitiesand before steel plate removed 6 months after surgery.3.Comparisons between control group and observation group in VAS score,AOFAS score and excellent rate after weight-bearing activitiesand 12 months after surgery.4.Comparisons of excellent rate at 6 months and 12 months of the control group.Comparisons of excellent rate at 6 months and 12 months of the observation group.5.Comparisons of postoperative complications between control group and observation group.Results: Follow-up was conducted for 16-24 months after two types of surgeries for Myerson type B and C Lisfranc complex injuries,(19.36±2.642).The data were statistically analyzed through SPSS25.0:(1)There was no statistical difference(P>0.05)between the two groups in gender,age,BMI,educational background,occupation,cause of injury,left or right foot and basic disease before surgery.Dates in two groups were comparable.(2)There was no significant difference in preoperative VAS score between the two groups(P>0.05).There was a statistical difference in operative time between the two groups(P<0.05).(3)There was no significant difference(P>0.05)between the time of bone healing and the time of taking full weight after surgery.(4)VAS and AOFAS scores were made before steel plate removed 6 months after surgery.There was no statistical difference(P>0.05)between excellent rate.(5)VAS and AOFAS scores were made 12 months after surgery.There was a statistical difference(P < 0.05)between excellent rate.(6)There were statistically significant differences(P<0.05)in the excellent rates between the observation group and the control group at 6 and 12 months,respectively.(7)Postoperative complications: There were more cases of middle foot stiffness in control group than that in observation group,with statistical significance(P<0.05).There were more cases of chronic pain in the control group than that in the observation group,without statistical significance(P > 0.05).Lisfranc repeat displacement > 1mm.There were more cases in the control group than that in the observation group without statistical significance(P>0.05).Conclusion: In this study,through the comparison between the treatment of Lisfranc complex injury with dorsal plate combined with ligament reconstruction and the treatment with simple dorsal plate before,during and after surgery,it is found that Lisfranc complex injury has achieved good effect after surgical treatment.However,based on AOFAS,VAS score and the analysis of complications,it was found that the treatment with dorsal plate combined with ligament reconstruction has a good long-term effect with better flexibility and stability of midfoot.