Lisfranc韧带损伤的多层螺旋CT及MRI表现

Multi-slice CT and MRI findings of the Lisfranc＇s ligament injuries

目的分析Lisfranc韧带损伤的MSCT及MR影像特点。方法23例跗跖关节损伤患者，男16例，女7例，年龄17～67岁，平均37岁。直接暴力损伤10例，间接暴力损伤13例。23例均行螺旋CT扫描，应用MPR、CPR、表面遮盖（SSD）及VR重组技术，其中10例行斜横断面、矢状面、冠状面MR扫描。结果CT显示14例第2跖骨基底与内侧楔状骨间隙增宽，第1、2跖骨基底间隙〉2mm，第2跖骨基底内侧骨折5处，内侧楔状骨外缘骨折5处，提示Lisfranc韧带损伤；14例第1、2跖骨基底间隙增宽的患者中10例行MR扫描，显示Lisfranc韧带均有损伤，并分为3型：1型Lisfranc韧带不同程度断裂5例；2型Lisfranc韧带形态完整，但伴有第2跖骨基底内缘Lisfranc韧带附着点撕脱骨折4例；3型Lisfranc韧带形态完整，但伴有内侧楔状骨外侧缘Lisfranc韧带附着点撕脱骨折1例。结论CT能显示局部软组织肿胀，提示Lisfranc韧带损伤，清晰地显示Lisfranc韧带附着点处撕脱骨折，MRI能够准确评价Lisfranc韧带损伤情况。

Objective To explore the muhislice CT and MRI features of the Lisfranc＇s ligament injuries. Methods In 23 cases of the tarsometatarsal joins injuries, 16 are men and 7 are women. The average age is 37 years（range 17-67 years）. Ten cases are induced by the direct force and 13 cases are caused by the indirect force. All of the 23 cases were examined by the Siemens 6d-slice CT scan , and then reformatted the tarsometatarsal joins with the MPR,CPR,SSD and VR. Ten of 23 cases were examined by oblique axial, sagittal and coronal view of the Siemens 1.5 T MRI. Results On CT , the distance between the second metatarsus base and the medial cuneiform showed increase in 14 cases and the distance between the base of the second metatarsus and the first metatarsus was over 2 mm. In addition, the inside base of the second metatarsus and the lateral edge of the first cuneiform bone revealed fractures in 5 cases, respectively. The above CT characteristics may suggest the injuries of Lisfranc＇s ligament. Ten of the 14 cases were examined by MRI. The Lisfranc ligament was found to have injuries in these cases. The injuries were divided into 3 types： type Ⅰ （Lisfranc ligament breaks ） was 5 cases; type Ⅱ （Lisfrane ligament shape is complete, but accompanied with avulsion fracture of the second metatarsal bone basis interior margin of attachment point of Lisfrane ligament） was 4 eases; and type Ill （Lisfrane ligament shape is complete, but accompanied with avulsion fracture of exterior margin of the inside cuneiform of attachment point of Lisfrane ligament） was 1 ease. Conclusion CT can demonstrate local soft tissue swelling, suggesting the Lisfrane ligament damage, and demonstrate clearly avulsion fracture of attachment point of Lisfrane ligament, but MRI can appraise accurately the Lisfranc ligament injuries.