跖跗关节韧带损伤：背侧钢板与经关节螺钉固定的生物力学比较
Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation.
作者信息
Alberta Frank G, Aronow Michael S, Barrero Mauricio, Diaz-Doran Vilmaris, Sullivan Raymond J, Adams Douglas J
机构信息
Active Orthopaedics and Sports Medicine, P.A., Westwood, NJ, USA.
出版信息
Foot Ankle Int. 2005 Jun;26(6):462-73. doi: 10.1177/107110070502600607.
BACKGROUND
The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates.
METHODS
The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition.
RESULTS
After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 +/- 0.7% for the medial cuneiform, 2.6 +/- 0.5% for the first metatarsal, 3.6 +/- 1.2% for the intermediate cuneiform, and 3.6 +/- 1.0% for the second metatarsal.
CONCLUSIONS
The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load.
CLINICAL RELEVANCE
Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.
背景
目前跗跖关节（TMT）移位性韧带损伤的治疗方法是采用经关节螺钉进行切开复位和坚强内固定。该技术会进一步损伤关节面，理论上可能增加患关节炎的风险。如果螺钉断裂，取出内固定物会很困难。一种避免这些潜在并发症的替代方法是使用背侧钢板进行坚强内固定。
方法
在10对匹配的新鲜冷冻尸体下肢上，测量在未负重和负重状态下第一跖骨与内侧楔骨、第二跖骨与中间楔骨、第一和第二跖骨基底以及内侧楔骨与第二跖骨基底之间的移位情况。切断Lisfranc韧带和TMT关节韧带后，在负重状态下再次进行测量。右脚的第一和第二TMT关节用3.5毫米皮质骨经关节螺钉固定，而左脚的则用2.7毫米1/4管状背侧钢板固定。然后在未负重和负重状态下再次进行测量。
结果
切断韧带后，负重时第一和第二TMT关节半脱位明显增加。在使第一和第二TMT关节重新对线以及在负重期间维持TMT关节对线的能力方面，钢板和螺钉直接比较未发现显著差异。一枚3.5毫米螺钉造成的关节面破坏量，内侧楔骨为2.0±0.7%，第一跖骨为2.6±0.5%，中间楔骨为3.6±1.2%，第二跖骨为3.6±1.0%。
结论
该模型可靠地产生了与Lisfranc韧带损伤相一致的第一和第二TMT关节移位。经关节螺钉和背侧钢板在TMT和Lisfranc韧带横断后减少第一和第二TMT关节移位以及抵抗负重时TMT关节移位的能力相似。
临床意义
在治疗移位性Lisfranc损伤时，背侧钢板固定可能是经关节螺钉固定的一种替代方法。
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