第2或3跖骨跖侧基底部撕脱性骨折——警惕隐匿性Lisfranc损伤  

Plantar Avulsion Fractures of the 2nd or 3rd Metatarsal Base:High Risk of Occult Lisfranc Injuries

作　　者：林健[1] 黄建华[1] 伍凯[1] 王秋根[1] 

机构地区：[1]上海交通大学附属第一人民医院南院创伤中心骨科,上海201620

出　　处：《华南国防医学杂志》2017年第1期36-39,共4页Military Medical Journal of South China

摘　　要：目的探讨计算机断层扫描(computed tomography,CT)检查提示跖跗关节无移位但第2或3跖骨跖侧基底部撕脱性骨折,警示是否有隐匿性Lisfranc损伤的风险。方法 2011-06/2015-10月,将第2或3跖骨跖侧基底部骨折的17例患者纳入研究。其中右侧10例,左侧7例。运动损伤5例,车祸外伤6例,重物砸伤6例。伴随损伤:2例合并肋骨骨折,2例合并头面部裂伤。所有患者在局部阻滞麻醉下行外展应力及模拟负重应力试验,对阳性患者作手术治疗;阴性患者行保守治疗,以短腿石膏托固定6周。遵循规范的康复锻炼及随访,采用美国骨科足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝关节与后足功能评分标准对患者功能恢复进行评估。结果应力试验显示:15例(88.24%)为阳性;仅2例(11.76%)为阴性。所有患者均获随访,随访时间12~18个月,平均16个月。末次随访时AOFAS后足功能评分75~100分,平均90.20分,其中优7例,良9例,一般1例,优良率94.12%。术后无伤口感染、无继发移位、无足部畸形、无创伤性骨关节炎等并发症。结论第2、3跖骨撕脱性骨折应作为一种CT征象提示Lisfranc关节在外伤时承受了巨大暴力,很可能同时发生隐匿性损伤,建议行应力试验以明确诊断并妥善治疗。Objective To explore the risk of occult Linsfranc injuries in patients whose computed tomogrophy（CT）scan showed only plantar avulsion fractures of the 2nd or 3rd metatarsal base without any displacement of tarsometatarsal joint.Methods From June 2011 to October 2015,CT scans of 17 patients were showed the 2nd or 3rd metatarsal base with plantar avulsion fractures but without any displacement of tarsometatarsal joint were admitted to this study.Ten of them were hurt on the right foot while 7 on the left.Five of the patients were injured during sports,6 were hurt in car accidents,and 6 were injured by a crushing object.Two participants accompanied with rib fractures and another 2 patients combined with facial laceration.Both abductive and simulated weight bearing stress test were applied for all the individuals after regional anesthesia.The positive patients were treated as close reduction and internal fixation,while the negatives were received conservative treatment with cast immobilization for 6 weeks.After regular rehabilitation and follow up,the outcomes were evaluated by American Orthopaedic Foot and Ankle Society（AOFAS）scores.Results Stress test results were showed15 patients（88.24%）were positive and only2individuals（11.76%）were negative.All the subjects were followed up averagely 16 months（range,12-18 months）.Average AOFAS scores at the latest follow-up was 90.2（range,75-100）,and the excellent and good rate was 94.12%,including7 excellents,9 goods and1 fairs.None of infection,secondary displacement,deformity or notable traumatic arthritis were observed.Conclusion No displacement in tarsometatarsal joint of CT scan is not an evidence of stability.Plantar avulsion fractures of the 2nd or 3rd metatarsal base should be regarded as an important sign which indicates the risk of occult Linsfranc injuries.

关 键 词：LISFRANC损伤 跖骨骨折 应力试验 

分 类 号：R274.12[医药卫生—中医骨伤科学]