Seo Dong-Kyo, Lee Ho-Seong, Lee Ki Won, Lee Suk Kyu, Kim Sang-Bum
1 Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea.
2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
Foot Ankle Int. 2017 Oct;38(10):1120-1125. doi: 10.1177/1071100717717220. Epub 2017 Jul 14.
A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries.
We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher's exact test.
Based on intraoperative findings, medial cuneiform (C1)-second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1-intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability ( P < .05).
C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint.
Level IV, retrospective case series.
由于初始X线片上表现轻微，中足扭伤很容易被漏诊，而这些X线片几乎都是非负重位的。我们研究了术前非负重位X线平片在被诊断为不稳定型隐匿性Lisfranc损伤患者中的应用情况。
我们回顾性分析了2004年2月至2015年3月间接受手术治疗的51例患者。比较术前X线片异常表现与术中不稳定情况。采用Fisher精确检验计算两者之间的关系。
根据术中所见，50例（98%）观察到内侧楔骨（C1）-第二跖骨（M2）不稳定，这是最常见的情况。39例（76.4%）存在多关节（至少2个）不稳定。在术前影像学表现中，C1-M2间隙增宽是最常见的异常表现，共46例（90.1%）。C1-M2撕脱、间隙增宽以及C1-中间楔骨（C2）间隙增宽的特异性和阳性预测值均为1.0。C1-C2、C1-M1和C2-M2的异常表现与术中不稳定存在显著相关性（P < .05）。
C1-M2撕脱、间隙增宽以及C1-C2间隙增宽是明确的术前不稳定预测指标。在不稳定型隐匿性Lisfranc损伤中，90%的患者在非负重位X线片上C1-M2关节至少有轻微的影像学异常。然而，对于C1-M2关节无影像学异常但存在不稳定的情况，应谨慎判断。
IV级，回顾性病例系列研究。
