Abstract：
Transarticular screw fixation is a common surgical treatment for tarsometatarsal ligamentous (Lisfranc) injuries. Iatrogenic damage to articular cartilage from screw placement, however, has been thought to potentially lead to increased risk of tarsometatarsal (TMT) joint arthritis after initial injury. To date, no study has evaluated the effect of weightbearing on articular cartilage after screw fixation. The aim of this study was to create a Lisfranc injury and quantify and compare articular damage due to screw fixation before and after simulated weightbearing.
A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed.
Simulated partial weightbearing increased articular injury 1.44-fold (P < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold, P = .0047), whereas the first (M1) showed the least (1.35-fold, P = .0083). Increases seen at the medial (1.43-fold, P = .0387) and middle cuneiform (1.44-fold, P = .0292) were intermediate between the values seen at M2 and M1.
Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries.
Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.
A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed.
Simulated partial weightbearing increased articular injury 1.44-fold (P < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold, P = .0047), whereas the first (M1) showed the least (1.35-fold, P = .0083). Increases seen at the medial (1.43-fold, P = .0387) and middle cuneiform (1.44-fold, P = .0292) were intermediate between the values seen at M2 and M1.
Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries.
Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.
摘要：
背景：经关节螺钉固定术是一种常见的骨掌韧带（Lisfranc）损伤的外科治疗方法。螺钉放置对关节软骨的医源性损伤，然而,已被认为有可能导致初始损伤后的骨掌（TMT）关节关节炎的风险增加。迄今为止,目前尚无研究评估承重对螺钉固定后关节软骨的影响。这项研究的目的是创建Lisfranc损伤，并量化和比较模拟承重前后螺钉固定引起的关节损伤。
■在10个尸体标本中创建了韧带Lisfranc损伤，并用经关节螺钉治疗。将样本在250N下循环1000个循环，以模拟2周的生理负重。测量了Lisfranc复合物的旋转和舒张。在模拟负重之前和之后，使用第一和第二TMT关节的数字成像测量关节损伤占总关节表面的百分比。对关节损伤进行比较并进行统计分析。
■模拟部分负重使关节损伤增加1.44倍（P<.001）。第二meta骨（M2）显示出最大的增加（1.54倍，P=.0047),而第一个(M1)显示的最少(1.35倍，P=.0083）。在内侧看到的增加（1.43倍，P=.0387)和中楔形文字(1.44倍，P=.0292）介于M2和M1处的值之间。
■模拟部分负重后，经关节螺钉固定引起的关节损伤显着增加。当使用经关节螺钉治疗韧带Lisfranc损伤时，这可能会增加关节炎的风险和未来的发病率。
■由于韧带Lisfranc损伤的螺钉固定对关节软骨的医源性损伤可能会随着负重而增加。
■在10个尸体标本中创建了韧带Lisfranc损伤，并用经关节螺钉治疗。将样本在250N下循环1000个循环，以模拟2周的生理负重。测量了Lisfranc复合物的旋转和舒张。在模拟负重之前和之后，使用第一和第二TMT关节的数字成像测量关节损伤占总关节表面的百分比。对关节损伤进行比较并进行统计分析。
■模拟部分负重使关节损伤增加1.44倍（P<.001）。第二meta骨（M2）显示出最大的增加（1.54倍，P=.0047),而第一个(M1)显示的最少(1.35倍，P=.0083）。在内侧看到的增加（1.43倍，P=.0387)和中楔形文字(1.44倍，P=.0292）介于M2和M1处的值之间。
■模拟部分负重后，经关节螺钉固定引起的关节损伤显着增加。当使用经关节螺钉治疗韧带Lisfranc损伤时，这可能会增加关节炎的风险和未来的发病率。
■由于韧带Lisfranc损伤的螺钉固定对关节软骨的医源性损伤可能会随着负重而增加。
