第1、2跖跗关节关节面的解剖研究及其临床意义

Anatomy of the 1st and 2nd Lisfranc joint surface and its clinical significance

目的观察螺钉贯穿第1、2跖跗关节关节面对关节面的损伤情况，为临床治疗跖跗l关=声损伤提供解剖学依据。方法2011年6—12月选取新鲜成年人足部标本20例进行研究。将足部标本从跖跗关节之间离断，确保跖跗关节面的软骨的完整性；采用数字表法随机将足部离断标本随机分成A、B组，每组10例。A组用1．0mm导针由跖骨向楔骨方向贯穿第1、2跖跗关节1次，拧入4．0mm空心钉固定；B组分别用1．0mm导针和4．0mm空心钉以同样方向贯穿第1、2跖跗关节2次。观察2组标本跖跗关节面的损伤情况，测量第1、2跖骨底关节面和楔骨远端内侧、中间关节面的面积，计算螺钉贯穿造成第1、2跖骨底以及楔骨远端内侧、中间关节面损伤的面积占相应关节面面积的比例。结果20例标本的第1、2跖骨底关节面及楔骨远端内侧、中间关节面的面积分别为（3．13±0．32）cm2、（2．15±0．31）cm2、（3．44±0．40）cm2、（1．70±0．30）cm2。A组10例标本的第1、2跖骨基底关节面和楔骨远端内侧、中间关节面损伤范围均为螺钉造成的孔洞，损伤面积占相应关节而面积的比例分别为5．11％±0．26％、7．44％±0．86％、4．65％±0．58％、9．41％±0．45％，孔洞周围关市面良好、无骨折。B组中10例标本的第1跖骨基底关节面、楔骨远端内侧关节面和6例标本的第2跖骨基底关节面、楔骨远端中间关节面损伤范围为螺钉造成的孔洞，2次螺钉贯穿造成关节面损伤的面积占相应关节面面积的比例分别为10．22％±0．67％、9．30％±0．32％、13．32％±0．38％、17．48％±0．84％，孔洞周围关节面良好、无骨折；另外4例标本的第2跖骨基底和楔骨远端中间关节面损伤范围较大，螺钉孔洞周围关节软骨面出现裂隙、骨折，2次螺钉贯穿造成关节面损伤的面积占相应关节面面积的比例分别为16．45％±0．57％、20．07％±0．55％。结论楔骨内侧关节面的面积略大于第1跖骨底关节面，楔骨中间关节面的面积略小于第2跖骨底关节面。跖跗关节2次植人导针及螺钉，町加大埘关节面的破坏范围。

Objective To explore anatomic features of the joint area of the first and second tarsometatarsal joints provide basis data for the treatment of tarsometatarsal joint injury. Methods Twenty normal adult feet specimens were dissected between the tarsometatarsal joint and ensure the integrity of tarsometatarsal joint surface cartilage to perform prospective study from June 2011 to December 201 l. The specimens were divided into groups A and B by random digital table method, 10 feet in each group. The joint area of the first and second tarsometatarsal joints were measured and analyzed respectively. Group A： with 1.0 mm Kirsehner wire and 4.0 mm eannulated screws through the first and second tarsometatarsal joint surface and measured the articular surface damage range. Group B with 2 Kirschner wire and cannulated screws as group A. Results The joint area of the base of the first and second metatarsal were （3. 13 ±0.32）era2 and （2. 15 ±0. 31 ）cm2, respectively. The joint area of the distal of the first and second cuneiform were（3.44±0.40 ） cm2 and （ 1.70± 0.30 ） cm2, respectively. In group A, the injury area proportions of screw across the first and second metatarsal bone were 5. 11%± 0. 26% and 7.44% ±0.86%. The injury area proportion of screw across the first and second cuneiform bone were 4.65%±0.58% and 9.41% ±0.45%. In group B, the injury area proportions of screw across the first metatars~ and ct,neifonn bone were 10.22%±0.67% and 9.30%±0.32%. in 6 feet of group B, the injury area proportion of screw across the second metatarsal and cuneiform bone were 13.32% ±0.38% and 17.48%± 0.84%. In the other four feet of group B, the injury of the second tarsometatarsal joints surthce was not only the diameter of the screws, but the joint surfaces also fracture. The injury area proportions of screw across the second metatarsal and cuneiform bones were 16.45% ±0.57% and 20.07%±0.55%. Conclusions Mean surface area of the first metatarsal base was smaller than that of the first cuncifirm. Mean surface area of the second metatarsal base was larger than that of the second cuneiform.