Wen Yi, Feng Pin, Zhang Hui, Tu Chong-Qi
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2013 Mar;44(2):222-5, 241.
To compare the stability provided by a allogeneic tendon with a screw for the treatment of ligamentous Lisfranc injury.
Six fresh-frozen, paired cadaveric feet were loaded in the condition of Lisfranc ligament-intact, injury and fixation models. With axial or abduction stress, the distance between medial cuneiform and second metatarsal was recorded.
With both two types of stress, there were statistically significant differences in motion detected between the intact and post-injury conditions (all P = 0.000), and the magnitudes were greater with abduction [(4.14 +/- 1.02) mm] than axial load [(1.60 +/- 0.64) mm]. In screw fixation group, the mean position changes under axial load and abduction load were (1.53 +/- 0.62) mm and (4.06 +/- 1.05) mm in post-injury model respectively, while the changes were (0.76 +/- 0.35) mm and (1.20 +/- 0.53) mm in the fixation model (all P = 0.000) which were not statistical different to that in the intact model. In allogeneic tendon fixation group, the mean position changes were (1.66 +/- 0.65) mm and (4.21 +/- 1.00) mm in the post-injury model, while were (0.90 +/- 0.41) mm and (1.33 +/- 0.61) mm in the fixation model (all P = 0.000) which also were not statistical different to that in the intact model.
Under abduction stress, a significantly greater difference was found between pre- and post-injury, which may be valuable for diagnosing and testing ligamentous Lisfranc injury. Allogeneic tendon fixation can provide similar stability as screw fixation in ligamentous Lisfranc injury.
比较同种异体肌腱联合螺钉治疗Lisfranc韧带损伤的稳定性。
对6对新鲜冷冻尸体足进行Lisfranc韧带完整、损伤及固定模型加载。施加轴向或外展应力，记录内侧楔骨与第二跖骨之间的距离。
在两种应力作用下，完整状态与损伤后状态之间检测到的运动差异具有统计学意义（所有P = 0.000），外展时的位移幅度[(4.14±1.02)mm]大于轴向载荷[(1.60±0.64)mm]。在螺钉固定组中，损伤后模型在轴向载荷和外展载荷下的平均位置变化分别为(1.53±0.62)mm和(4.06±1.05)mm，而在固定模型中变化分别为(0.76±0.35)mm和(1.20±0.53)mm（所有P = 0.000），与完整模型相比无统计学差异。在同种异体肌腱固定组中，损伤后模型的平均位置变化分别为(1.66±0.65)mm和(4.21±1.00)mm，而在固定模型中分别为(0.90±0.41)mm和(1.33±0.61)mm（所有P = 0.000），与完整模型相比也无统计学差异。
在外展应力下，损伤前后差异明显增大，这可能对诊断和检测Lisfranc韧带损伤具有重要价值。同种异体肌腱固定在Lisfranc韧带损伤中可提供与螺钉固定相似的稳定性。
