Lisfranc关节损伤相关解剖及临床诊断研究进展  

Recent advances in anatomy and clinical diagnosis of Lisfranc joint injuries

作　　者：邢丹[1] 马剑雄[2] 马信龙[3] 

机构地区：[1]天津市公安医院骨科,300042 [2]天津医科大学总医院骨科生物力学实验室 [3]天津市天津医院骨科研究所生物力学实验室

出　　处：《中国骨与关节杂志》2013年第2期103-107,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金项目(81102607);天津市科技支撑重点项目(11ZCGYSY01800);天津市卫生局科技攻关项目(11KG137)

摘　　要：Lisfranc关节通常指跖跗关节复合体，早在1815年法国外科医师Jaqcues Lisfranc de Saint-Martin在为一位士兵治疗前足坏疽载肢时，发现通过这个关节的截肢可以不截断骨骼，且省时省力，并获得良好的效果，从此以其名字命名。Lisfranc关节损伤发生率低，约占全身骨折的0．2％。随着建筑、交通等行业的迅速发展，高能量损伤的数量逐渐增多，Lisfranc关节损伤呈逐年上升的趋势。Lisfranc joint injuries usually refer to fractures or dislocations of the tarsometatarsal joint complex. The Lisfranc joint consists of 3 parts： the medial column, middle column and lateral column. The medial column is formed by the base of the 1st metatarsal and the medial cuneiform, the middle column is formed by the bases of the 2nd and 3rd metatarsals and the middle and lateral cuneiforms, and the lateral column is formed by the bases of the 4th and 5th metatarsals and the cuboids. Injuries can be caused by direct or indirect forces. The spectrum of injuries ranges from low energy sports injuries to high energy injuries. The 2 most common injury mechanisms： high energy injuries caused by motor vehicle accidents and low energy injuries caused by falls from height. Quénu and Kuss divided Lisfranc injuries into 3 categories： isolated, homolateral, and divergent injuries. The Myerson classification continues to be used today, which plays an important role in treating instable and comminuted fractures. The Lisfranc joints provide the bony structural support for the transverse arch in the midfoot, and the injuries account for approximately 0.2% of that all over the body. Early diagnosis is critical to preserve normal foot function and biomechanics performance. However, up to 20% of Lisfranc injuries are misdiagnosed or missed at present. If such injuries were overlooked or not treated correctly, painful malunion and impaired function would appear, often accompanying by vascular injuries. Therefore, strong vigilance of Lisfranc injuries must be emphasized when evaluating any patient complaining of midfoot pain or any multi-wounded patient. The main clinical features may be the plantar ecchymosis and pain. In patients with a high index of suspicion, the passive abduction and pronation of the forefoot should be performed on the premise of assuring the hindfoot stable. The purpose of the present review was to explain the anatomy and diagnosis of Lisfranc joint injuries, based on which Lisfranc injuries could be

关 键 词：关节损伤 临床诊断 相关解剖 损伤发生率 高能量损伤 跖跗关节 外科医师 全身骨折 

分 类 号：R687.4[医药卫生—骨科学]