Lisfranc损伤的手术治疗研究进展

Progress in surgical treatment of Lisfranc injuries

[目的]跗跖关节损伤即Lisfranc损伤,是以法国军医Jacques Lisfranc的名字命名的,他首次介绍了前足严重损伤行经跗跖关节面截肢术治疗的经验,现代医学所谓的Lisfranc损伤是指跗跖关节的脱位及骨折,可为单纯的韧带损伤或涉及骨质的损伤,该损伤类型临床上较罕见,但有较高的漏诊率,较复杂的局部解剖结构,多变的损伤机制及较差的术后效果加大了此类损伤的诊断及治疗难度。一些术后患者,尤其未明确诊断者后期常发生创伤性关节炎及顽固性疼痛,对日常生活产生严重影响。全面的检查包括影像学检查、体格检查对于明确诊断非常必要,目前观点对于改善患者后期功能倾向于选择手术治疗。随着医疗科技日益创新,以及相关研究进一步深入,对于lisfranc损伤的手术治疗日益进步,置入物种类日益丰富。现就Lisfranc关节的解剖结构、损伤机制、损伤分型及手术治疗方法做以下综述。

Lisfranc injuries are fracture- dislocations to the tarsometatarsal joints, named after Jacques Lisfranc who first introduced the experience of amputation through the tarsometatarsal joint. These injuries can be purely ligamentous or involve the osseous structures in the foot, and are relatively rare, but the high level of miss diagnosis, the complexity of the topography of midfoot, diversity of injuries mechanism and the unsatisfied post - operational outcomes add to the difficulty of accurate diagnosis and optimal chose of treatment. Several patients may result in complications like posttraumatic arthritis and persistent pain and even long - term disability for the severe ones, especially when miss diagnosed. Comprehensive radiographic and physical exami- nations are necessary for accurate diagnosis, and for these injuries ,the majority of the opinions tend to agree that surgical treatment may result in better outcomes. With the developing medical technology and further relevant studies, surgical techniques for Lisfranc injuries have made great progress. Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes.