■早期发现Lisfranc损伤对于改善临床结果至关重要,但是诊断细微的损伤可能很困难。称重计算机断层扫描(WBCT)允许在生理负荷下以3维(3D)评估此类损伤。本研究旨在评估1-,2-,和WBCT的3维测量,以诊断孤立的韧带Lisfranc损伤中的细微损伤。
■十个尸体标本在完整状态下对Lisfranc关节复合体进行了WBCT评估,随后对背侧Lisfranc韧带和骨间Lisfranc韧带(IOL)进行了顺序切片,以造成细微的Lisfranc损伤,最后在切断足底Lisfranc韧带(PLL)后,为完全韧带Lisfranc损伤创造了损伤条件。在WBCT图像上进行了80kg的静态垂直胫骨负荷下的测量,包括(1)Lisfranc关节(第二meta骨的内侧楔形基部)体积,(2)Lisfranc联合区,(3)C1-C2楔形文字区域,(4)C1-M2距离,(5)C1-C2距离,(6)M1-M2的距离,(7)第一睑板(TMT1)对齐,(8)第二睑板(TMT2)对准,(9)TMT1背侧步离距离,和(10)TMT2背侧步离距离。
■在微妙的Lisfranc受伤状态下,Lisfranc关节体积和面积,C1-M2距离,WBCT上的M1-M2距离测量显着增加,与完整状态相比(P值.001至.014)。此外,Lisfranc关节体积和面积,C1-M2距离,M1-M2距离,TMT2校准,在Lisfranc完全损伤状态下,TMT2背侧步离测量值增加。在所有测量中,C1-M2距离的最大曲线下面积(AUC)为0.96(灵敏度=90%;特异性=90%),其次是Lisfranc体积(AUC=0.90;灵敏度=80%;特异性=80%)和Lisfranc面积(AUC=0.89;灵敏度=80%;特异性=100%)。
■在尸体模型中,我们发现WBCT扫描可以提高对Lisfranc细微损伤的诊断准确性。在测量中,C1-M2距离表现出最高的精度水平。2D关节面积和3D关节体积也被证明是准确的,Lisfranc关节的3D体积测量显示完整状态和Lisfranc损伤严重程度之间的最显著绝对差异。这些发现表明,2D关节面积和3D关节体积可能具有补充测量的潜力,可以更准确地诊断细微的Lisfranc损伤。
■WBCT可以帮助外科医生发现Lisfranc细微的损伤。
UNASSIGNED: Early detection of Lisfranc injury is critical for improving clinical outcomes, but diagnosing subtle injury can be difficult. Weightbearing computed tomography (WBCT) allows evaluation of such injuries in 3 dimensions (3D) under physiologic load. This study aimed to assess the utility of 1-, 2-, and 3-dimensional measurements on WBCT to diagnose subtle injury in isolated ligamentous Lisfranc injuries.
UNASSIGNED: Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc injury, and finally after transectioning of plantar Lisfranc ligament (PLL) to create the injury conditions for complete ligamentous Lisfranc injury. Measurements under static vertical tibial load of 80 kg were performed on WBCT images including (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 intermetatarsal distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step-off distance, and (10) TMT2 dorsal step-off distance.
UNASSIGNED: In the subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance, and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values .001 to .014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment, and TMT2 dorsal step-off measurements were increased in the complete Lisfranc injury state. Of all measurements, C1-M2 distance had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%).
UNASSIGNED: In a cadaveric model we found that WBCT scan can increase the diagnostic accuracy for subtle Lisfranc injury. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D joint area and 3D joint volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc injury. These findings suggest that 2D joint area and 3D joint volume may have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries.
UNASSIGNED: WBCT may help surgeons detect subtle Lisfranc injuries.