Lisfranc损伤

IF 0.1 Q4 ORTHOPEDICS
C. Gentchos
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引用次数: 1

摘要

Lisfranc损伤是一种异质性的韧带损伤和跗骨/跗骨中关节骨-韧带联合损伤。高能Lisfranc损伤很少出现迟发性。手术治疗包括经皮复位内固定、切开复位内固定和原发性关节融合术(PA)。高能损伤的预后可能较差,如果不作为主要治疗,通过继发性关节融合术进行挽救仍然是一种选择。轻微的、能量较低的损伤或纯粹的韧带损伤通常会被忽视。这些损伤通常需要多种成像方式来完全确定,最佳治疗方法仍然存在争议。人们普遍认为,无论手术治疗,受影响关节的解剖复位是最大限度地发挥功能和减少疼痛的关键。一项前瞻性随机对照试验支持PA治疗韧带性Lisfranc损伤,一项回顾性比较研究报道PA治疗韧带和骨-韧带联合损伤的结果同样有利。一项前瞻性随机对照试验和所有其他回顾性比较研究和荟萃分析得出结论,对于韧带或联合损伤,PA并不优于切开复位内固定。对于先前失败的非关节融合术治疗,关节融合术仍然是一个成功的选择。证据等级:诊断级III。有关证据水平的完整描述,请参见作者说明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lisfranc Injuries
Lisfranc injuries represent a heterogenous group of ligamentous and combined osseous-ligamentous injuries to the tarsometatarsal/midtarsal articulations. Higher-energy Lisfranc injuries rarely present delayed. Operative treatments have included percutaneous reduction internal fixation, open reduction internal fixation, and primary arthrodesis (PA). Outcomes in higher-energy injuries can be poor and salvage by secondary arthrodesis, if not performed as primary treatment, remains an option. Subtle, lower-energy injuries, or purely ligamentous Lisfranc injuries may be commonly overlooked. These injuries frequently require multiple imaging modalities to fully define, and optimal treatment continues to be controversial. It is universally agreed that regardless of surgical treatment, anatomic reduction of the affected joints is critical to maximize function and minimize pain. One prospective randomized controlled trial supports PA for ligamentous Lisfranc injuries and 1 retrospective comparative study reported PA results similarly favorable in both ligamentous and combined osseous-ligamentous injuries. One prospective randomized controlled trial and all other retrospective comparative studies and meta-analyses concluded that PA is not superior to open reduction internal fixation for ligamentous or combined injuries. Arthrodesis remains a successful option for failed prior nonarthrodesis treatments. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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来源期刊
CiteScore
0.40
自引率
0.00%
发文量
18
期刊介绍: Techniques in Foot & Ankle Surgery offers a unique opportunity to master the most innovative and successful surgical techniques for correction of foot and ankle disorders. Featuring contributions from the world"s foremost orthopaedic surgeons and podiatrists, this quarterly journal supplies step-by-step details on these techniques. The contributors explain the rationale, indications, and contraindications for each procedure, identify the pitfalls and potential complications, and provide invaluable tips for improving results. The journal is illustrated cover to cover with intraoperative photographs and drawings, including several in full color.
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