运动员Lisfranc损伤的诊疗策略及研究进展

Lisfranc injury in an athletic population:diagnostic and therapeutic strategies

背景:运动员Lisfranc损伤多为隐匿性或低能量损伤。尤其对于高水平或专业运动员患者,其治疗方法的最佳选择一直是足踝损伤研究中争议的焦点。关于运动员Lisfranc损伤的治疗方法也在不断改进和发展。目的:总结运动员Lisfranc损伤的诊疗策略及与手术相关问题。方法:应用计算机检索Pub Med和Web of science数据库中1909年6月至2014年6月关于Lisfranc损伤诊疗方面的文章,以"Lisfranc,injury,athletes"为检索词进行检索;排除与研究内容无关和内容重复的文章,保留43篇文章进行综述。结果与结论:随着运动员Lisfranc关节损伤治疗方法的不断改进,缝合纽扣装置、生物可吸收螺钉作为新型治疗方法,具有恢复或保留跖跗关节稳定性的潜力,同时可避免内固定激惹的潜在风险或拔除内固定的必要性,但仍需多中心、前瞻性、随机性临床研究来进一步确定此类损伤的最佳治疗。对于Lisfranc关节损伤的患者,选择最佳的治疗方法、把握内固定拔除时机及根据患者运动量的大小实施恰当的术后功能锻炼,对其恢复至先前的运动水平也至关重要。

BACKGROUND：Lisfranc injury is a concealed or low-energy damage in the athletic population. The optimal treatment strategies for Lisfranc injury in the athletes, especial y for high-level or professional athletes, remain controversial. Improvement and development in treatment for Lisfranc injury are ongoing. OBJECTIVE：To summarize the diagnostic and therapeutic strategies and problems in surgery in Lisfranc injuries in the athletic population. METHODS：A computer-based online search was conducted in PubMed and Web of science databases from June 1909 to June 2014 to screen the relevant articles regarding the diagnostic and therapeutic strategies for Lisfranc injury using the key words“Lisfranc, injury, athletes”. The irrelevant and duplicate articles were excluded, and final y 43 articles were reviewed. RESULTS AND CONCLUSION：With the improvement and development in the therapeutic methods for Lisfranc injury, suture button fixation and bioabsorbable screw technology, as novel treatment strategies, have the potential to help restore and/or preserve stability at the tarsometatarsal joints, to avoid the potential risk for internal fixation irritation or the need for removal of hardware after fixation. However, more multi-center, prospective, randomized control ed clinical trials are required for seeking the optimal treatment for Lisfranc injury. For the athletes with Lisfranc injury, the best treatment option, removal timing of internal fixation devices, and the proper postoperative function exercise performed according the conditions of patients are vital for restoring the professional sports level.