轻微Lisfranc损伤的诊断和评估:计算机断层摄影和负重x线摄影的比较。

IF 1.5 4区 医学 Q3 ORTHOPEDICS
Hiroki Ukita, Masanori Taki, Naohiro Hio, Nao Ito, Kazunari Oshima
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引用次数: 0

摘要

背景:轻微的Lisfranc损伤会引起Lisfranc关节周围的不稳定,如果没有适当的治疗,会导致足部功能的丧失。常用的基于负重x线片的Nunley分类的诊断准确性是有争议的。我们比较了Nunley分类和计算机断层扫描(CT)对轻微Lisfranc损伤严重程度的发现。方法:回顾性分析51例诊断为轻微Lisfranc损伤的患者。剔除无负重x线片及CT影像者,回顾33例患者的病史、负重x线片及CT影像。我们测量了正位x线片上第一和第二近端跖骨之间的距离以及侧位x线片上第一楔形骨跖骨和第五跖骨跖骨之间的距离,然后根据Nunley分类对病例进行分类。CT图像评估撕脱碎片在Lisfranc韧带复合体附着部位。结果:按照Nunley分型,ⅰ期7例,ⅱ期23例,ⅲ期3例。根据负重x线片,C1-M5距离为1.29±0.40 cm/1.01±0.36 cm(受伤足/对侧足;P < 0.05)。在CT图像上,撕脱骨碎片定位显示1例骨间Lisfranc韧带,5例足底关节囊Lisfranc韧带复合体,为Nunley i期。在Nunley II期,3例为背囊Lisfranc韧带复合体,15例为骨间韧带,18例为足底关节囊Lisfranc韧带复合体。在Nunley III期,2例患者有骨间Lisfranc韧带,3例患者有足底囊Lisfranc韧带复合体。结论:轻微Lisfranc损伤的急性期患者不会将重量放在受伤的足上。在93.9%的轻微Lisfranc损伤病例中,韧带附着部位存在撕脱碎片,其严重程度与负重x线片不同。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnosis and assessment of subtle Lisfranc injuries: Comparison of computed tomography and weight-bearing radiography.

Background: Subtle Lisfranc injuries cause instability around the Lisfranc joint, leading to loss of foot function without appropriate treatment. The diagnostic accuracy of the commonly used Nunley classification, which is based on weight-bearing radiographs, is controversial. We compared the Nunley classification and computed tomography (CT) findings for subtle Lisfranc injury severity.

Methods: Fifty-one patients diagnosed with subtle Lisfranc injury were retrospectively enrolled. After excluding those without weight-bearing radiography or CT images, the medical histories, weight-bearing radiographs, and CT images of 33 patients were reviewed. We measured the distance between the proximal first and second metatarsals from the anteroposterior radiographs and that between the plantar aspect of the first cuneiform and plantar aspect of the fifth metatarsals from the lateral view and then classified the cases according to the Nunley classification. CT images were evaluated for avulsion fragments at the Lisfranc ligament complex attachment sites.

Results: According to the Nunley classification, seven patients were stage I, 23 were stage II, and three were stage III. Based on weight-bearing radiographs, the C1-M5 distance was 1.29 ± 0.40 cm/1.01 ± 0.36 cm (injured feet/contralateral feet; p < 0.05) overall. On CT images, the avulsion bone fragment location revealed one case of interosseous Lisfranc ligament and five cases of plantar capsular Lisfranc ligament complex in Nunley stage I. In Nunley stage II, three patients had a dorsal capsular Lisfranc ligament complex, 15 had an interosseous Lisfranc ligament, and 18 had a plantar capsular Lisfranc ligament complex. In Nunley stage III, two patients had interosseous Lisfranc ligaments, and three patients had a plantar capsular Lisfranc ligament complex.

Conclusions: Patients in the acute phase of subtle Lisfranc injury did not place weight on their injured foot. In 93.9 % of subtle Lisfranc injury cases, avulsion fragments were present at the ligament attachment site, and severity was different from weight-bearing radiographs.

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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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