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.
■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。