PDF(Pubmed)
Abstract：
UNASSIGNED: Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear.
UNASSIGNED: To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation.
UNASSIGNED: Systematic review; Level of evidence, 4.
UNASSIGNED: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed.
UNASSIGNED: Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs -0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load.
UNASSIGNED: Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
UNASSIGNED: To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation.
UNASSIGNED: Systematic review; Level of evidence, 4.
UNASSIGNED: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed.
UNASSIGNED: Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs -0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load.
UNASSIGNED: Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
摘要：
■柔性韧带固定在韧带Lisfranc损伤的治疗中越来越受欢迎，但最佳固定策略尚不清楚。
■回顾生物力学，临床,和弹性固定治疗韧带Lisfranc损伤的影像学结果。
■系统评价；证据水平，4.
■根据PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统文献综述。查询PubMed/Medline和GoogleScholar文献数据库，以进行与韧带Lisfranc损伤的柔性固定有关的临床和生物力学（尸体）研究。感兴趣的结果包括患者报告的结果评分，临床/生物力学结果，射线照相校准，并返回到活动。在适当的情况下，对术后结局进行荟萃分析。
■在34项初步研究中，分析中包括14篇文章(243英尺)。在11项临床研究（216例患者）中，术后美国骨科足踝协会平均评分为90.1分(n=150;6项研究),视觉模拟量表平均评分为1.5分(n=137;5项研究).活动回报率为100%(n=35；5项研究)，100％的患者术后保持影像学检查（n=62；6项研究）。没有报告并发症或随后的硬件移除。在3项生物力学研究中（27英尺），1项研究发现，与螺钉固定相比，在轴向负荷下，完整和固定后的韧带之间的分离变化明显更大（1.1对-0.1mm；P<0.05），另一个发现在轴向负荷下，受伤状态与螺钉或缝线按钮固定之间的舒张减少没有差异（1.2对1.0mm；P=.5），第三个发现在任一轴向下，完整的和螺钉或缝合按钮固定之间的位移没有差异(完整的vs螺钉:1.0vs2.0毫米，P=.1；完整与缝合按钮：0.6与1.8毫米，P=.1）或外展（完整vs螺钉：1.5vs1.1mm，P=.5；完整与缝合按钮：1.3与2.1毫米，P=.1)载荷。
■发现在韧带Lisfranc损伤的治疗中使用灵活的固定作为固定选择具有重要的潜力，如优秀的临床结果所证明。生物力学证据尚无定论，但表明与缝合纽扣相比，用螺钉固定的标本存在减少剥离的趋势。
■回顾生物力学，临床,和弹性固定治疗韧带Lisfranc损伤的影像学结果。
■系统评价；证据水平，4.
■根据PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统文献综述。查询PubMed/Medline和GoogleScholar文献数据库，以进行与韧带Lisfranc损伤的柔性固定有关的临床和生物力学（尸体）研究。感兴趣的结果包括患者报告的结果评分，临床/生物力学结果，射线照相校准，并返回到活动。在适当的情况下，对术后结局进行荟萃分析。
■在34项初步研究中，分析中包括14篇文章(243英尺)。在11项临床研究（216例患者）中，术后美国骨科足踝协会平均评分为90.1分(n=150;6项研究),视觉模拟量表平均评分为1.5分(n=137;5项研究).活动回报率为100%(n=35；5项研究)，100％的患者术后保持影像学检查（n=62；6项研究）。没有报告并发症或随后的硬件移除。在3项生物力学研究中（27英尺），1项研究发现，与螺钉固定相比，在轴向负荷下，完整和固定后的韧带之间的分离变化明显更大（1.1对-0.1mm；P<0.05），另一个发现在轴向负荷下，受伤状态与螺钉或缝线按钮固定之间的舒张减少没有差异（1.2对1.0mm；P=.5），第三个发现在任一轴向下，完整的和螺钉或缝合按钮固定之间的位移没有差异(完整的vs螺钉:1.0vs2.0毫米，P=.1；完整与缝合按钮：0.6与1.8毫米，P=.1）或外展（完整vs螺钉：1.5vs1.1mm，P=.5；完整与缝合按钮：1.3与2.1毫米，P=.1)载荷。
■发现在韧带Lisfranc损伤的治疗中使用灵活的固定作为固定选择具有重要的潜力，如优秀的临床结果所证明。生物力学证据尚无定论，但表明与缝合纽扣相比，用螺钉固定的标本存在减少剥离的趋势。
