Kennelly Hannah, Klaassen Kassey, Heitman Daniel, Youngberg Rhys, Platt Simon R
Department of Orthopaedic Surgery, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2019 Oct;31(5):741-744. doi: 10.1111/1742-6723.13237. Epub 2019 Feb 19.
The goal of the present study was to compare the diagnostic yield of weight-bearing radiographs with non-weight-bearing computed tomography (CT) scan for subtle Lisfranc (LF) injuries in the ED.
Retrospective analysis of patients presenting with a suspected LF injury over a 2 year period from 2016 to 2017 who had both weight-bearing bilateral foot radiographs and CT scan. Information extracted included patient demographics, radiographic findings of metatarsal fractures, fleck sign and measurements of diastasis between the medial cuneiform and second metatarsal expressed as a ratio of the uninjured side, clinical findings and treatment modality. Radiologist reports were recorded as either positive, negative or equivocal for a LF injury.
A total of 117 patients were included with a mean age of 38 years and 54% (n = 63) women. When initial weight-bearing radiographs were positive, 54% of subsequent CT scans were reported as either equivocal or negative. Of the patients who had a negative or equivocal weight-bearing radiograph, only 12% had a positive CT scan. The mean diastasis ratio in patients undergoing surgery was 1.53 (95% confidence interval 1.41-1.65) compared to 1.11 (95% confidence interval 1.07-1.16) for patients with injuries not requiring operative intervention (P < 0.001). There was a statistically significant correlation between a positive weight-bearing radiograph and surgical treatment (R = 0.339, P < 0.001), and between diastasis measurements and surgical treatment (R = 0.576, P < 0.001).
CT provides limited benefit in the diagnosis and initial management of suspected subtle LF injuries in the ED. We advocate for the use of bilateral weight-bearing radiographs as a first-line investigation.
本研究的目的是比较负重X线片与非负重计算机断层扫描（CT）对急诊科隐匿性Lisfranc（LF）损伤的诊断效能。
回顾性分析2016年至2017年期间因疑似LF损伤就诊且同时进行了双侧足部负重X线片和CT扫描的患者。提取的信息包括患者人口统计学资料、跖骨骨折的影像学表现、斑点征以及内侧楔骨与第二跖骨间分离的测量值（以健侧的比例表示）、临床发现和治疗方式。放射科医生对LF损伤的报告记录为阳性、阴性或不明确。
共纳入117例患者，平均年龄38岁，女性占54%（n = 63）。当初始负重X线片为阳性时，后续CT扫描中有54%报告为不明确或阴性。在负重X线片为阴性或不明确的患者中，只有12%的CT扫描为阳性。接受手术治疗患者的平均分离比例为1.53（95%置信区间1.41 - 1.65），而无需手术干预的损伤患者为1.11（95%置信区间1.07 - 1.16）（P < 0.001）。负重X线片阳性与手术治疗之间存在统计学显著相关性（R = 0.339，P < 0.001），分离测量值与手术治疗之间也存在相关性（R = 0.576，P < 0.001）。
CT在急诊科疑似隐匿性LF损伤的诊断和初始管理中的获益有限。我们主张将双侧负重X线片作为一线检查方法。
