Main B J, Jowett R L
J Bone Joint Surg Br. 1975 Feb;57(1):89-97.
Injuries involving the midtarsal joint, which are frequently misdiagnosed, have been studied to clarify the mechanism, classification and treatment. The necessity for routine antero-posterior, lateral and oblique radiographs is emphasised. Seventy-one injuries have been classified according to the direction of the deforming force:medial, longitudinal compression, lateral, plantar and crush types are described. Included in the medial and lateral types is a hitherto undescribed tarsal rotation or "swivel" injury. The mechanism whereby longitudinal compression causes fractures of the body of the navicular is described, and two varieties having different prognoses are defined: one due to purely longitudinal compression and the other due to longitudinal compression with a medial component. The results of treatment have been assessed clinically and radiologically. Reduction, open if necessary, with internal fixation, is recommended for displace fractures: primary arthrodesis is not indicated. For severe persistent symptoms from medial and longitudinal force injuries triple arthrodesis is recommended, and from lateral force injuries, calcaneo-cuboid arthrodesis.
涉及中跗关节的损伤常被误诊，现对其损伤机制、分类及治疗方法进行研究以加以明确。强调常规拍摄前后位、侧位及斜位X线片的必要性。根据致伤力的方向对71例损伤进行了分类：描述了内侧、纵向压缩、外侧、跖侧及挤压型损伤。内侧和外侧型损伤中包括一种此前未描述过的跗骨旋转或“旋转”损伤。阐述了纵向压缩导致舟骨体骨折的机制，并明确了两种预后不同的类型：一种是单纯纵向压缩所致，另一种是纵向压缩合并内侧成分所致。已从临床和影像学方面对治疗结果进行了评估。对于移位骨折，建议进行复位，必要时切开复位并内固定：不建议一期关节融合术。对于内侧和纵向暴力损伤导致的严重持续症状，建议行三关节融合术；对于外侧暴力损伤，建议行跟骰关节融合术。
