Curtis M J, Myerson M, Szura B
Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, Maryland 21218.
Am J Sports Med. 1993 Jul-Aug;21(4):497-502. doi: 10.1177/036354659302100403.
This is a retrospective review of the presentation, diagnosis, treatment, and outcome of 19 patients who injured the tarsometatarsal joint of the foot during athletic activity. Diagnosis by clinical and radiographic examination was supplemented by stress fluoroscopy of the articulation under anesthesia. Injuries were classified as either a first- or second-degree sprain of the tarsometatarsal joint, a third-degree sprain (with diastasis between the metatarsals or cuneiforms), a fracture, or frank dislocation. Poor functional results were seen in those for whom diagnosis was delayed and for whom the injury was not treated adequately. Three patients were unable to return to sports, one of whom eventually required fusion of the tarsometatarsal joint. The third-degree sprains were indistinguishable from fracture and fracture-dislocations in that good results were not reliably obtained by nonoperative treatment, and both classes of injury seem to require open reduction and internal fixation for optimal return to function. The delay in return to full activity is a marker of the severity of this injury despite an often benign appearance on radiograph.
这是一项对19例在体育活动中足部跗跖关节受伤患者的临床表现、诊断、治疗及预后的回顾性研究。临床和影像学检查诊断辅以麻醉下关节应力荧光透视检查。损伤分为跗跖关节一度或二度扭伤、三度扭伤（跖骨或楔骨间有分离）、骨折或完全脱位。诊断延误且损伤未得到充分治疗的患者功能预后较差。3例患者无法恢复运动，其中1例最终需要进行跗跖关节融合术。三度扭伤与骨折及骨折脱位难以区分，因为非手术治疗无法可靠地获得良好效果，这两类损伤似乎都需要切开复位内固定以实现最佳功能恢复。尽管X线片上通常表现为良性，但恢复完全活动的延迟是这种损伤严重程度的一个标志。
