Lisfranc损伤MDCT表现及临床意义

Multi-detector CT Findings in Lisfranc Injury and the Clinic Values

目的：探讨Lisfranc损伤MDCT表现及其临床应用价值。资料与方法：临床表现符合Lisfranc损伤患者31例,致伤原因车祸伤21例,坠落伤8例,碾压伤2例。28例手术治疗,受伤后立即常规拍摄足部数字X线正、斜位片,3例加摄侧位片;3日内行64排CT平扫及后处理重建,重建方式包括容积再现（VR）和多平面重组（MPR）。结果：31例患者CT检查均发现有骨折,其中单处骨折3例,2处骨折13例,3处及3处以上骨折15例,共89处;均发现关节脱位,共57处,其中关节面错位≤2 mm的9处,〉2~5 mm的30处,〉5 mm的18处。骨折累及关节面时相应关节均发生脱位。与CT结果比较,X平片漏诊骨折13处（14.61%）,不能确定骨折16处（16.86%）;漏诊关节脱位14处（25.56%）。结论：Lisfranc损伤的CT表现主要是Lisfranc关节构成骨的骨折和关节脱位,骨折线累及关节面提示相应处韧带损伤。CT表现可作为临床治疗方案选择的重要依据。

Objective： To investigate the features of the multi-detector CT in Lisfranc injury and its clinical value. Materials and Methods： 31 patients whose clinical manifestation were consistent with Lisfranc injury were included in this study. 21 cases were injured by traffic accidents, 8 cases were by falling, and 2 cases were mangled injury. All patients underwent foot anteroposterior and oblique position X-ray plain film immediately, and 3 patients were underwent foot lateral position X-ray plain film. MDCT scan were performed within 3 days. The raw data of CT scan were reconstructed with the VR （valume rendering） and MPR （multiplanar reconstruction）. Results： Fractures and dislocation of tarsometatarsal joint were detected by CT in 31cases. 89 fractures were detected, the fracture occurred in one part in 3cases, in two parts in 13 cases, and more than 3 parts in 15 cases. 57 disloeationhs were detected, the dislocation 〈 2 mm was occurred in 9 parts, 〉 2 ~5 mm in 30 parts, and 〉 5 mm in 18 parts. Dislocation occurred when fracture line involved the articular facet. Compare with CT scan, the missed diagnosing rate of X-ray plain film is 14.61% in fracture and 25.56% in dislocation. Conclution： CT features of Lisfranc injury include fracture and dislocation of tarsometatarsal joint. Fracture line involved the articular facet indicats ligaments injure. CT features of Lisfranc injury is valuable to the choice of its treatment.