Jarde O, Trinquier-Lautard J L, Filloux J F, de Lestang M, Vives P
Service d'Orthopédie-Traumatologie, Hôpital Nord, Amiens.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(8):724-30.
Classicaly Lisfranc fractures dislocations are unusual. Our study is based on 69 observations from January 1974 to January 1992.
Fractures occured during tremendous impacts with a sex ratio of two men for one woman. The authors insist on the diagnostic value of good quality standard x-rays. Using Trillat's classification, we had 19 homolateral spatular fractures dislocations, 22 homolateral columno-spatular, 8 divergent columnar and 19 divergent columno spatular. A dislocation was reduced in emergency before radiography. The treatment consisted in orthopedic reduction and plaster 7 times, percutaneous kwire 2 times, immediate arthrodesis 5 times, open reduction and internal fixation with kwires 55 times. Post-operatively, 8 complications were noticed. 11 secondary arthrodesis were made with reference to failures of previous methods. They have been performed from 9 months to 5 years after the initial traumatism due to a painful ankylosis in bad position or arthrosis. The arthrodesis was total 6 times, partial lateral 2 times, partial medial 3 times.
63 patients were reviewed with a minimum follow-up evaluation of two years and a maximum of 9 years. The results show that we must reduce the tarsometatarsal fracture dislocations even if the displacement is minimal and we must fix them. The most satisfactory means seem to be open reduction if the least anatomical defect exists. Immediate, total arthrodesis reposition is suitable when an important articular comminution exists. If the total secondary arthrodesis reposition gives good results, its realization is sometimes difficult. The lateral partial arthrodesis must be discontinued, because they don't seem logical. The medial partial arthrodesis didn't prove its superiority, compared with total arthrodesis.
The reduction of Lisfranc's dislocation is essential. The single case not unreduced has given a bad result as shown in the litterature. When the orthopedic treatment is well-made, the result is good. The open reduction followed by an axial fixation has only given 56 per cent of good results. The main reason of these bad results is an important comminution which should have practised an immediate arthrodesis reposition and a bad reduction. We must be aware on the quality of the anatomical reduction. The secondary arthrosis appeared principally in cases where the reduction was defective (13 observations out of 50). The 5 immediate arthrodesis have all given a good result.
The retrospective study of the series teaches us to reduce the tarsometatarsal fractures dislocations even if the displacement is minimal and to fix them. We must make a wider place to the immediate arthrodesis reposition.
经典的Lisfranc骨折脱位并不常见。我们的研究基于1974年1月至1992年1月间的69例观察病例。
骨折发生于巨大冲击时，男女比例为2:1。作者强调高质量标准X线片的诊断价值。采用Trillat分类法，我们有19例同侧跖跗关节骨折脱位，22例同侧柱-跖跗关节骨折脱位，8例分离性柱形骨折脱位和19例分离性柱-跖跗关节骨折脱位。脱位在急诊时于摄片前复位。治疗方法包括骨科复位及石膏固定7次，经皮克氏针固定2次，一期关节融合5次，切开复位并用克氏针内固定55次。术后发现8例并发症。因先前治疗方法失败，1例患者在初次创伤后9个月至5年进行了11次二期关节融合。关节融合完全性的6次，外侧部分性的2次，内侧部分性的3次。
对63例患者进行了复查，随访时间最短2年，最长9年。结果表明，即使跖跗关节骨折脱位移位极小，也必须进行复位并固定。如果存在最小的解剖学缺陷，最令人满意的方法似乎是切开复位。当存在严重的关节粉碎时，一期完全性关节融合复位是合适的。如果二期完全性关节融合复位效果良好，但其实施有时困难。外侧部分性关节融合必须停止，因为它们似乎不合理。与完全性关节融合相比，内侧部分性关节融合并未证明其优越性。
Lisfranc脱位的复位至关重要。如文献所示，唯一未复位的病例结果不佳。当骨科治疗做得很好时，结果良好。切开复位后轴向固定仅有56%的良好结果。这些不良结果的主要原因是严重的粉碎，应进行一期关节融合复位且复位不佳。我们必须关注解剖复位的质量。继发性关节炎主要出现在复位有缺陷的病例中（50例中有13例观察病例）。5例一期关节融合均取得了良好效果。
该系列的回顾性研究告诉我们，即使跖跗关节骨折脱位移位极小，也应进行复位并固定。我们必须为一期关节融合复位留出更大的空间。
