Chona Deepak V, Park Caroline N, Kim Billy I, Lau Brian C
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USA.
Orthop J Sports Med. 2023 Aug 1;11(8):23259671231186387. doi: 10.1177/23259671231186387. eCollection 2023 Aug.
Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear.
To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation.
Systematic review; Level of evidence, 4.
A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed.
Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs -0.1 mm; < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, = .1; intact vs suture button: 0.6 vs 1.8 mm, = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, = .5; intact vs suture button: 1.3 vs 2.1 mm, = .1) load.
Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
柔性韧带固定在治疗韧带性Lisfranc损伤中越来越受欢迎，但最佳固定策略尚不清楚。
回顾采用柔性固定治疗韧带性Lisfranc损伤的生物力学、临床和影像学结果。
系统评价；证据等级，4级。
根据PRISMA（系统评价和Meta分析的首选报告项目）指南进行系统文献综述。在PubMed/Medline和谷歌学术文献数据库中查询与韧带性Lisfranc损伤柔性固定相关的临床和生物力学（尸体）研究。感兴趣的结果包括患者报告的结果评分、临床/生物力学结果、影像学对线情况以及恢复活动情况。在适当情况下，对术后结果进行Meta分析。
在34项初始研究中，14篇文章（243足）纳入分析。在11项临床研究（216例患者）中，术后美国矫形足踝协会平均评分为90.1（n = 150；6项研究），平均视觉模拟量表评分为1.5（n = 137；5项研究）。恢复活动率为100%（n = 35；5项研究），100%的患者术后维持影像学对线（n = 62；6项研究）。未报告并发症或后续取出内固定物的情况。在3项生物力学研究（27足）中，1项研究发现，与螺钉固定相比，使用缝线纽扣固定时，完整韧带和固定后韧带在轴向负荷下的分离变化显著更大（+1.1 vs -0.1 mm；P <.05），另一项研究发现，损伤状态与螺钉或缝线纽扣固定在轴向负荷下分离减少方面无差异（1.2 vs 1.0 mm；P =.5），第三项研究发现，在轴向（完整 vs 螺钉：1.0 vs 2.0 mm，P =.1；完整 vs 缝线纽扣：0.6 vs 1.8 mm，P =.1）或外展（完整 vs 螺钉：1.5 vs 1.1 mm，P =.5；完整 vs 缝线纽扣：1.3 vs 2.1 mm，P =.1）负荷下，完整韧带与螺钉或缝线纽扣固定之间的位移无差异。
如出色的临床结果所示，柔性固定用于治疗韧带性Lisfranc损伤作为一种固定选择具有显著潜力。生物力学证据尚无定论，但提示与缝线纽扣相比，螺钉固定的标本分离有减少趋势。
