Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
Orthopaedic Surgical Specialty Care, McGuire VA Medical Center, Richmond, Virginia, USA.
J Orthop Res. 2022 Dec;40(12):2856-2864. doi: 10.1002/jor.25308. Epub 2022 Mar 11.
Ligamentous Lisfranc injuries cause debilitating pain and loss of function. Even small diastasis of this normally rigid joint after injury requires surgical treatment, but outcomes remain poor. Existing literature has compared the different surgical procedures using cadaveric models, but no approach has been recommended over others. This study uses a computational biomechanical approach consistent with a cadaveric study to evaluate the different procedures' ability to stabilize the Lisfranc joint without inducing secondary consequences. A validated rigid body model for the cadaver foot with a Lisfranc injury was extended to compare the stability of four different surgical repairs-three open reduction and internal fixation procedures with different hardware (cannulated screws, endobuttons, and screws with a dorsal plate) and primary arthrodesis with screws. Forces calculated from the rigid body model for 50% partial weight bearing provided boundary conditions for a finite element model of the surgical repairs. Comparing the different surgical procedures, the open reduction and internal fixation with screws and primary arthrodesis with screws showed the most stable postoperative Lisfranc joint. However, the use of cannulated screws for fixation showed regions of high stress that may be susceptible to breakage and also resulted in higher contact forces in joints adjacent to the surgery site. Endobuttons and dorsal plates did not restore sufficient stability. Since all procedures showed different points of concern that could impact outcomes, additional surgical approaches could be needed in the future. This study offers a standard protocol for benchmarking the new procedures against those currently used.
Lisfranc 韧带损伤会导致严重的疼痛和功能丧失。即使是这种通常坚固关节在受伤后的微小分离也需要手术治疗，但结果仍然不佳。现有文献已经比较了使用尸体模型的不同手术程序，但没有一种方法被推荐优于其他方法。本研究使用与尸体研究一致的计算生物力学方法来评估不同手术程序在不引起继发性后果的情况下稳定 Lisfranc 关节的能力。一个经过验证的带有 Lisfranc 损伤的尸体足部刚体模型被扩展，以比较四种不同手术修复的稳定性，即三种不同硬件（空心螺钉、Endobutton 和带背侧板的螺钉）的切开复位内固定术和带螺钉的一期融合术。从 50%部分负重的刚体模型计算的力为手术修复的有限元模型提供了边界条件。比较不同的手术程序，带螺钉的切开复位内固定术和带螺钉的一期融合术显示术后 Lisfranc 关节最稳定。然而，用于固定的空心螺钉显示出高应力区域，可能容易断裂，并且还导致手术部位附近关节的接触力增加。Endobutton 和背侧板没有恢复足够的稳定性。由于所有程序都显示出不同的关注点，这些关注点可能会影响结果，因此未来可能需要额外的手术方法。本研究提供了一个标准协议，用于将新程序与当前使用的程序进行基准测试。
