目的:本综述的目的是确定Lisfranc损伤的手术指征。
方法:使用MEDLINE文献检索进行了系统评价,从1980年开始,使用PRISMA(系统评价和荟萃分析的首选报告项目)指南使用索引“LisfrancInjury”进行了系统评价。纳入标准是通过搜索索引获得的所有报告Lisfranc损伤管理的临床研究,包括病例报告,评论文章,队列研究,和随机试验。非英语文章,无法访问的文章,那些与Lisfranc损伤的管理无关的(生物力学,尸体,和技术文章),未明确说明手术指征(模糊或无指征)的患者被排除.
结果:在确定了737项研究后,回顾了391项研究的全文,最终分析中纳入了58份明确的手术适应症报告.51项(81.1%)研究提供了≥2mm的舒张截止值(35/58;60.4%),≥1mm(13;22.4%),≥3mm(3;5.2%);舒张位置最常见的是未指定(31/58;53.5%)或在meta骨组合之间变化,tarsal,长方体,楔形骨(20/58;27.6%)。手术的特定影像学标准包括撕脱性骨折或斑点征(3/58;5.2%),拱高损失(3/58;5.2%),和磁共振成像撕裂(5;8.6%)。根据Nunley和Vertullo的分类方案定义手术适应症的11项(19%)研究(8/58;13.8%),迈尔森(2;3.5%),和Buehren(1;1.7%)系统。21项(36.2%)研究提供了多种手术适应症。
结论:在有限的报告研究中,最常见的Lisfranc手术适应症在几个位置从1-到3-mm不等。必须以更高的频率和同质的方式报告手术适应症,以指导这些细微损伤的临床管理。
■四级;系统评价。
OBJECTIVE: The aim of this
review was to determine operative indications for Lisfranc injuries.
METHODS: A systematic
review using a MEDLINE literature search was performed using the index \"Lisfranc Injury\" from 1980 onward using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines where applicable. Inclusion criteria were all clinical studies reporting on the management of Lisfranc injuries obtained via the search index, including case reports,
review articles, cohort studies, and randomized trials. Non-English-language articles, inaccessible articles, those not relevant to the management of Lisfranc injuries (biomechanical, cadaveric, and technique articles), and those that did not explicitly state operative indications (vague or absent indications) were excluded.
RESULTS: After identifying 737 studies, the full text of 391 studies was reviewed, and 58 reports providing explicit operative indications were included in the final analysis. Fifty-one (81.1%) studies provided diastasis cutoffs varying ≥2 mm (35/58; 60.4%), ≥1 mm (13; 22.4%), and ≥3 mm (3; 5.2%); the diastasis location was most commonly unspecified (31/58; 53.5%) or varied between combinations of metatarsal, tarsal, cuboid, and cuneiform bones (20/58; 27.6%). Specific imaging criteria for surgery included an avulsion fracture or fleck sign (3/58; 5.2%), arch height loss (3/58; 5.2%), and a tear on magnetic resonance imaging (5; 8.6%). The 11 (19%) studies defining operative indications in terms of classification schemes used the Nunley and Vertullo (8/58; 13.8%), Myerson (2; 3.5%), and Buehren (1; 1.7%) systems. Twenty-one (36.2%) studies provided multiple operative indications.
CONCLUSIONS: The most common Lisfranc operative indications among the limited reporting studies varied from a 1- to 3-mm diastasis across several locations. It is imperative for operative indications to be reported with an increased frequency and in a homogenous fashion to guide the clinical management of these subtle injuries.
UNASSIGNED: Level IV; systematic
Review.