Sutter-PAMF, Department of Sports Medicine, Palo Alto, CA.
Aboite Podiatry, Fort Wayne, IN.
J Foot Ankle Surg. 2022 May-Jun;61(3):471-478. doi: 10.1053/j.jfas.2021.08.013. Epub 2021 Sep 22.
Injury to Lisfranc's joint complex affects the longitudinal and transverse arches of the foot and can significantly alter its biomechanics. Some of the previous studies have suggested primary arthrodesis to be superior to open reduction and internal fixation for treating primarily ligamentous Lisfranc injuries. Additionally, arthrodesis is often used for treating chronic Lisfranc injuries, including those which previously underwent open reduction and internal fixation and subsequently developed arthrosis. The purpose of this study was to retrospectively evaluate the outcomes of arthrodesis at the level of Lisfranc's articulation for both acute and chronic injuries. Patients who underwent midfoot arthrodesis surgical procedures between years 2001 and 2017 were retrospectively reviewed. About 187 patients with an average age of 55.9 ± 13.2 years old and a minimum follow-up of 1 year were included in the study. Median time to return to preoperative activities was 11 weeks. Overall successful joint fusion rate was 81.4%. However, concomitantly fused joints of the midfoot and hindfoot, in addition to the tarsometatarsal joints (TMTJ), were included in the overall fusion rate. Fusion rate at the first TMTJ was 90.2% (101 out of 112), second TMTJ was 94.4% (67 out of 71), and third TMTJ was 97.8% (45 out of 46). The present study demonstrates that patients who undergo arthrodesis for both acute and chronic Lisfranc injuries typically can return to activity in under approximately 3 months postoperatively (acute patients significantly faster) with a high union rate at the TMTJs. However, the overall union rate is significantly lower when concomitant proximal midfoot and rearfoot arthrodesis procedures are performed.
Lisfranc 关节复合体损伤会影响足的纵弓和横弓，并显著改变其生物力学特性。一些先前的研究表明，对于主要韧带性 Lisfranc 损伤，初次融合术优于切开复位内固定。此外，融合术常用于治疗慢性 Lisfranc 损伤，包括那些先前接受切开复位内固定后发展为关节炎的损伤。本研究旨在回顾性评估 Lisfranc 关节融合术治疗急性和慢性损伤的疗效。回顾性分析了 2001 年至 2017 年间接受中足融合手术的患者。共纳入 187 例患者，平均年龄 55.9±13.2 岁，随访时间至少 1 年。中位重返术前活动时间为 11 周。总体关节融合成功率为 81.4%。然而，在总体融合率中，除了跗跖关节（TMTJ）之外，还包括同时融合的中足和后足关节。第一 TMTJ 的融合率为 90.2%（112 例中的 101 例），第二 TMTJ 为 94.4%（71 例中的 67 例），第三 TMTJ 为 97.8%（46 例中的 45 例）。本研究表明，接受 Lisfranc 急性和慢性损伤融合术的患者通常可以在术后约 3 个月内（急性患者更快）恢复活动，TMTJ 的融合率较高。然而，当同时进行近侧中足和后足融合术时，总体融合率显著降低。
