Xia Jiang, Li Bing, Zhou Haichao, Yu Tao, Yu Guangrong, Yang Yunfeng
Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Apr 15;35(4):426-430. doi: 10.7507/1002-1892.202009066.
To evaluate the effectiveness of indirect fixation of the 3rd tarsometatarsal joint in the treatment of high-energy Lisfranc injury.
Between February 2015 and February 2019, 15 patients with high-energy Lisfranc injury were treated. There were 12 males and 3 females with an average age of 44.8 years (range, 29-73 years). The average time from injury to admission was 8.8 hours (range, 2-28 hours). According to Myerson classification, there were 6 cases of type A, 4 cases of type B2, 1 case of type C1, and 4 cases of type C2; 8 cases were open injury. The 3rd tarsometatarsal joint was injured in all patients, including intact intermetatarsal ligament in 7 cases, the 2nd-3rd intermetatarsal ligament injury in 6 cases, the 3rd-4th intermetatarsal ligament injury in 1 case, and the 2nd-3rd-4th intermetatarsal ligament injury in 1 case. Among them, the 3rd tarsometatarsal joint was not fixed directly and indirectly fixed by stabilized the 2nd and 4th tarsometatarsal joints in 13 cases. The 3rd tarsometatarsal joint was fixed with Kirschner wire in 2 cases for 1 patient had complete injury of the intermetatarsal ligament and the other 1 had comminuted fracture of the base of the 3rd metatarsal. The reduction of fracture and dislocation was evaluated by X-ray films, focusing on the re-displacement of the 3rd tarsometatarsal joint. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score.
Thirteen of the 15 patients were followed up 12-26 months, with an average of 15.6 months. One case had superficial infection of the incision and healed after symptomatic treatment; the other incisions healed by first intention. At last follow-up, the VAS score was 0-3 (mean, 1.1) and the AOFAS score was 70-99 (mean, 87.5). Twelve patients achieved anatomical reduction and 1 patient had increased talar-first metatarsal angle and the mild forefoot abduction. During the follow-up, no loss of reduction of the 3rd tarsometatarsal joint was found, while the spontaneous fusion of the joint was observed in 2 patients.
In high-energy Lisfranc injury, as long as the intermetatarsal ligament is not completely destroyed and the bony structure of the tarsometatarsal joint is intact, the 3rd tarsometatarsal joint does not need to be fixed routinely, the stability of the joint can be obtained indirectly by fixing the adjacent tarsometatarsal joint.
评估间接固定第3跖跗关节治疗高能量型Lisfranc损伤的疗效。
2015年2月至2019年2月，收治15例高能量型Lisfranc损伤患者。其中男12例，女3例，平均年龄44.8岁（29 - 73岁）。受伤至入院平均时间为8.8小时（2 - 28小时）。按Myerson分型，A型6例，B2型4例，C1型1例，C2型4例；开放性损伤8例。所有患者均有第3跖跗关节损伤，其中7例跖间韧带完整，6例第2 - 3跖间韧带损伤，1例第3 - 4跖间韧带损伤，1例第2 - 3 - 4跖间韧带损伤。其中13例未直接固定第3跖跗关节，而是通过稳定第2、4跖跗关节间接固定。2例患者因1例跖间韧带完全损伤、另1例第3跖骨基底粉碎性骨折，采用克氏针固定第3跖跗关节。通过X线片评估骨折脱位复位情况，重点关注第3跖跗关节的再移位。采用美国足踝外科协会（AOFAS）评分和视觉模拟评分法（VAS）评估疗效。
15例患者中13例获12 - 26个月随访，平均15.6个月。1例切口浅表感染，经对症治疗后愈合；其余切口均一期愈合。末次随访时，VAS评分为0 - 3分（平均1.1分），AOFAS评分为70 - 99分（平均87.5分）。12例患者达到解剖复位，1例距骨 - 第1跖骨角增大，前足轻度外展。随访期间，未发现第3跖跗关节复位丢失，2例患者出现关节自发融合。
在高能量型Lisfranc损伤中，只要跖间韧带未完全破坏，跖跗关节骨结构完整，第3跖跗关节无需常规固定，通过固定相邻跖跗关节可间接获得关节稳定性。
