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跗跖(Lisfranc)关节复合体损伤

Authors
Anthony Beutler, MD
Cole Taylor, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
刘丹平, 主任医师

引言

跗跖(tarsometatarsal, TMT)关节复合体通常也被称为Lisfranc关节，其很少发生损伤，但损伤常被漏诊且常导致骨关节炎和长期功能障碍。跗跖关节复合体损伤诊断延迟和处理不当时，产生此类不良结局的风险将显著提高。Lisfranc关节得名于Jacques L Lisfranc，他是一名法国妇科医师，也在拿破仑的军队中担任外科医生。他描述了一台经跗跖关节线的截肢术，患者是一名因坠马而发生足中段损伤的士兵[1]。

本文将总结跗跖关节复合体损伤的表现、诊断和处理。其他常见的足部损伤和骨折将单独讨论。 (参见“成年人足痛常见病因的评估和诊断”和“跖骨干骨折”和“第五跖骨近端骨折”和“足舟骨应力性骨折”和“Cuboid and cuneiform fractures”)

流行病学

跗跖关节复合体急性损伤约占所有骨折与脱位的0.1%-0.4%[2]。不幸的是，此类损伤在初次评估中的漏诊或误诊率将近20%[3]。跗跖关节复合体损伤可由机动车碰撞、高处坠落或户外运动(如美式橄榄球)等情况产生的直接或间接创伤导致。

临床解剖学

评估跗跖关节复合体损伤及决定损伤是否需要转诊外科时，医生需要了解足中段的解剖结构。跗跖关节复合体的骨性部分包括5个跖骨、3个楔骨和骰骨(图 1和图 2)。第一跖骨(与第一足趾相连)到第三跖骨(连于中趾)的基底部以及它们与楔骨形成的关节一同构成了足横弓(或称为Roman弓)(图 3)[4,5]。在这一弓内，第二跖骨起着拱顶石的作用，与其他5块足骨形成关节。如果第二跖骨与中楔骨之间发生脱位，则常伴有第三跖骨至第五跖骨脱位。

Lisfranc韧带，亦称骨间斜韧带，是跗跖关节复合体最强的支持结构[6]。它把第二跖骨基底部的内缘与内侧楔骨的外侧部分连接起来(图 4)。同样从内侧楔骨走行至第二跖骨的足底和足背韧带加强了这一连接(图 5和图 6)。在这3条斜韧带中，Lisfranc韧带强度最高，能承受的负荷约为足背韧带的2倍[7]。

              

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Literature review current through: 2017-06 . | This topic last updated: 2016-06-28.
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