Lisfranc关节损伤不同影像学检查特征及临床意义  

Manifestations of different imaging methods of Lisfranc joint injury and their clinical significance

作　　者：丁有泉 Ding Youquan(Radiography Center,the First People's Hospital of Wenling,Wenling 317500,Zhejiang Province,China)

机构地区：[1]温岭市第一人民医院放射影像中心,浙江省317500

出　　处：《中国基层医药》2021年第9期1368-1372,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨Lisfranc关节损伤不同检查方法的主要影像学表现以及分型,为临床提高Lisfranc关节损伤诊断率提供理论依据。方法回顾性分析温岭市第一人民医院2017年1月至2020年1月收治的Lisfranc关节损伤238例患者临床资料,根据损伤类型的不同按照Myerson分型和Nunley-Vertullo分型进行分型和统计分析,观察X线、CT、MRI等影像学检查的特征。结果238例患者中,Lisfranc关节骨折并脱位者175例,Myerson分型:Ⅰ型18例,Ⅱ型例149,Ⅲ型8例;Lisfranc关节损伤或扭伤63例,Nunley-Vertullo分型Ⅰ型14例,Ⅱ型45例,Ⅲ型4例。只做X线检查8例,只做CT检查10例,只做MRI17例;做X线和CT检查172例,做X线和MRI检查13例,做CT和MRI检查13例,三项检查均做5例。首次X线诊断正确率为85.35%(169/198),其中157例Myerson分型中诊断正确率为92.36%(145/157);41例Nunley-Vertullo分型中诊断正确率65.85%(27/41),两者差异有统计学意义(χ^(2)=5.135,P=0.024);CT检查患者中累及M2基底部占88.50%(177/200),累及M2~M4基底部占64.00%(128/200),M2存在外侧脱位占65.00%(130/200)。三维重建后背侧脱位或半脱位者占37.00%(74/200),跖侧脱位或半脱位者占7.50%(14/200)。MRI检查中I度损伤患者6例,表现为信号异常但无中断,Ⅱ度损伤患者24例,表现为韧带部分断裂,Ⅲ度损伤患者18例,表现为韧带完全断裂,图像中可见韧带信号中断或是消失。结论Lisfranc关节损伤的不同诊断方法中,X线检查存在一定漏诊的情况,对于临床中高度怀疑Lisfranc关节损伤且X线检查阴性的患者,需加做CT或是MRI检查。Objective To investigate the manifestations of different imaging methods of Lisfranc joint injury and their classification,providing a theoretical basis for increasing the rate of diagnosis of Lisfranc joint injury.Methods The clinical data of 238 patients with Lisfranc joint injury who received treatment in the First People's Hospital of Wenling from January 2017 to January 2020 were retrospectively analyzed.According to the different types of injury,the clinical data were classified into Myerson and Nunley-Vertullo types and then statistically analyzed.The features of X-ray,CT and MRI images of injured Lisfranc joint were observed.Results Among the 238 patients,175 had Lisfranc joint fracture and dislocation,with Myerson classification type I 18 patients,type II 149 patients,and type III 8 patients;63 had Lisfranc joint injury or sprain,with Nunley-Vertullo classification type I 14 patients,type II 45 patients and type III 4 patients.Only X-ray examination was performed in 8 patients,only CT scan in 10 patients,and only MRI in 17 patients.Both X-ray examination and CT scan were performed in 172 patients,both X-ray examination and MRI in 13 patients,both CT scan and MRI in 13 patients,and all X-ray examination,CT scan and MRI in 5 patients.The correct rate of the first X-ray diagnosis was 85.35%(169/198).In 157 patients with Myerson-type Lisfranc joint injury,the correct rate of diagnosis was 92.36%(145/157).In 41 patients with Nunley-Vertullo-type Lisfranc joint injury,the correct rate of diagnosis was 65.85%(27/41).There was significant difference in the correct rate of diagnosis between Myerson-type and Nunley-Vertullo-type Lisfranc joint injury(χ^(2)=5.135,P=0.024).CT scan examination invovled the basal part of M2 in 88.50%(177/200)of patients,the basal part of M2-M4 in 64.00%(128/200)of patients,and the lateral dislocation of M2 in 65.00%(130/200)of patients.Three-dimensional reconstructions revealed that 37.00%(74/200)of patients had dorsal dislocation or subluxation and 7.50%(14/200)of patients had metat

关 键 词：足损伤 跖趾关节 跗关节 X线 磁共振成像 体层摄影术 X线计算机 

分 类 号：R683[医药卫生—骨科学] R445.2[医药卫生—外科学] R816.8[医药卫生—临床医学]