Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
Skeletal Radiol. 2020 Jan;49(1):31-53. doi: 10.1007/s00256-019-03282-1. Epub 2019 Jul 31.
To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.
PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool.
Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice.
While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.
系统回顾目前用于评估跖跗关节的诊断成像选择。
系统检索了 PubMed 和 ScienceDirect。根据成像方式将 30 篇文章分为以下几类：常规放射摄影（17 篇）、超声检查（6 篇）、计算机断层扫描（CT）（4 篇）和磁共振成像（MRI）（11 篇）。有些文章讨论了多种方式。提取了以下数据：成像方式、测量方法、参与者数量、敏感度、特异度和测量技术准确性。采用 QUADAS-2 工具评估方法学质量。
常规放射摄影通常通过评估第一和第二跖骨基底（M1-M2）或内侧楔骨和第二跖骨基底（C1-M2）之间的距离以及每个跖骨基底与其连接的跗骨之间的吻合度来评估跖跗关节损伤。对于超声检查，评估 C1-M2 距离和背侧跖跗韧带（DLL）长度和厚度。CT 可明确跗跖关节（TMT）关节对线和 X 线片上隐匿性骨折。大多数 MRI 研究评估了跖跗韧带完整性。总体而言，除患者选择外，纳入研究的所有领域均显示出低偏倚，适用于日常实践。
虽然常规放射摄影可以显示 TMT 关节的明显分离；但在负重时，放射摄影可以提高观察者发现细微跖跗损伤的能力。尽管超声检查可以评估 DLL，但它诊断跖跗不稳定的准确性仍未得到证实。CT 比放射摄影更有利于检测未移位骨折和微小的骨半脱位。MRI 显然是检测韧带异常的最佳方法；然而，其检测细微跖跗不稳定的实用性需要进一步研究。总体而言，现有研究的方法学质量令人满意。
