University Orthopaedic Center, Salt Lake City, UT 84108, USA.
Foot Ankle Int. 2011 Apr;32(4):422-31. doi: 10.3113/FAI.2011.0422.
We hypothesized that using a cadaveric Lisfranc ligamentous injury model, abduction stress would provoke greater post-injury motion than axial weightbearing between the medial cuneiform (MC1) and the base of the second metatarsal (MT2). Second, we hypothesized that both a tensioned suture-button device and a rigid screw fixation method could maintain a reduction and similarly restrain motion to intact (pre-injury) levels.
Motion was measured between MC1 and MT2 in five matched pairs of human cadaveric feet. Specimens were tested prior to injury, following a transverse ligamentous Lisfranc injury, and then randomized to either screw or tensioned suture-button fixation. Axial then abduction loads were applied. Measurements were repeated after one thousand loading cycles.
With both axial and abduction loads, statistically significant differences in motion were detected between the intact and post-injury conditions, although the magnitudes were greater with abduction (6.8 mm versus 2.0 mm, p = 0.000004). With abduction loads, both fixation methods were effective in restraining motion to pre-injury levels (screw fixation: 1.5 mm intact versus 1.1 mm post-fixation, p = 0.487; suture-button fixation: 1.3 mm intact versus 2.1 mm post-fixation, p = 0.063), and similarly, both devices restrained motion to less than post-injury levels (screw fixation: 8.1 mm post-injury versus 1.1 mm post-fixation, p = 0.001; suture-button fixation: mean 5.5 mm post-injury versus 2.1 mm post-fixation, p = 0.0002). No significant differences in these patterns were detected following cyclic loading.
Small, though statistically significant, amounts of motion are produced between MC1 and MT2 with axial loading after a ligamentous Lisfranc injury. With abduction stress, we were able to show a significantly greater difference between pre- and post-injury motion and the ability of both fixation methods to restrain motion to pre-injury levels.
Abduction stress may be valuable when diagnosing and testing the transverse ligamentous Lisfranc injury. Both suture-button and screw fixation methods restrain motion at the Lisfranc complex.
我们假设，在尸体的跖跗关节韧带损伤模型中，外展应力会导致内侧楔骨（MC1）和第二跖骨基底（MT2）之间的损伤后运动比轴向负重更大。其次，我们假设张力缝线纽扣装置和刚性螺钉固定方法都可以维持复位并类似地限制运动到完整（损伤前）水平。
在五对匹配的人尸体脚上测量 MC1 和 MT2 之间的运动。标本在损伤前、横向跖跗关节韧带损伤后进行测试，然后随机分为螺钉或张力缝线纽扣固定组。施加轴向和外展负荷。在一千次加载循环后重复测量。
在轴向和外展负荷下，在完整和损伤后条件之间检测到运动有统计学显著差异，尽管外展时幅度更大（6.8 毫米对 2.0 毫米，p = 0.000004）。在外展负荷下，两种固定方法都能有效地将运动限制在损伤前水平（螺钉固定：1.5 毫米完整与 1.1 毫米固定后，p = 0.487；缝线纽扣固定：1.3 毫米完整与 2.1 毫米固定后，p = 0.063），同样，两种装置都将运动限制在损伤后水平以下（螺钉固定：8.1 毫米损伤后与 1.1 毫米固定后，p = 0.001；缝线纽扣固定：平均 5.5 毫米损伤后与 2.1 毫米固定后，p = 0.0002）。在循环加载后，没有检测到这些模式的显著差异。
在韧带性跖跗关节损伤后，轴向加载会导致 MC1 和 MT2 之间产生微小但有统计学意义的运动。在外展应力下，我们能够显示出预损伤和损伤后运动之间有显著更大的差异，以及两种固定方法将运动限制在损伤前水平的能力。
外展应力在诊断和测试横向跖跗关节韧带损伤时可能很有价值。缝线纽扣和螺钉固定方法都能限制跖跗关节复合体的运动。
