CAJ | 학술논문

背景：跖跗关节(Lisfranc关节)结构复杂、常规X射线片骨关节面重叠，对其诊断较困难。目前对Lisfranc韧带的解剖学研究较少，缺乏相应的形态学资料，导致在相关修复手术中没有该部位的准确解剖参考值。目的：测量Lisfranc韧带的静态稳定结构，为Lisfranc关节损伤的修复提供临床解剖学基础。方法：①对18侧成人尸体标本进行解剖，观察Lisfranc韧带的组织形态并进行测量，得到Lisfranc韧带的详细形态参数，作为解剖组，确定Lisfranc韧带的走行和骨性标志；其余14侧成人尸体标本按以上参数用导针固定得出相应Lisfranc韧带相关数据，作为实验组，对比两组测量角度与内侧楔骨到第二跖骨基底长度。②对8例临床上确认的Lisfranc 损伤患者应用解剖学获得的参数和定位法行切开复位螺钉置入内固定治疗，内固定后随访8-14个月，采用美国足踝外科学会踝-后足评分进行功能评估。结果与结论：①通过解剖观察得出，解剖出的Lisfranc韧带均为2束。解剖组及实验组形态学测量结果比较差异无显著性意义(P>0.05)。为了方便临床应用，作者提出“Lisfranc通道”这一概念，将Lisfranc通道定义为内侧楔骨(无韧带区)到第二跖骨基底部长(31.65±2.23) mm、宽(8.16±1.37) mm、高(1.69±0.21) mm、与内侧楔骨近端成(45.83±6.84)°角、与内侧楔骨跖侧成(65.11±4.69)°角的一条通道。通过做苏木精-伊红染色后，了解到Lisfranc韧带与周围组织的组织学特性：从层次上分为Lisfranc肌腱、潮线、矿化纤维软骨、骨等4层结构。②8例Lisfranc损伤患者应用解剖学获得的参数和定位法进行切开复位内固定后均获得较高的美国足踝外科学会踝-后足评分，为(80.30±4.85)分。解剖实验获得了Lisfranc关节及韧带详细的形态学参数，为该部位修复提供了解剖学资料，避免盲目置入内固定物，造成Lisfranc韧带起点的损伤，影响Lisfranc韧带修复效果。揹景：蹠跗關節(Lisfranc關節)結構複雜、常規X射線片骨關節麵重疊，對其診斷較睏難。目前對Lisfranc韌帶的解剖學研究較少，缺乏相應的形態學資料，導緻在相關脩複手術中沒有該部位的準確解剖參攷值。目的：測量Lisfranc韌帶的靜態穩定結構，為Lisfranc關節損傷的脩複提供臨床解剖學基礎。方法：①對18側成人尸體標本進行解剖，觀察Lisfranc韌帶的組織形態併進行測量，得到Lisfranc韌帶的詳細形態參數，作為解剖組，確定Lisfranc韌帶的走行和骨性標誌；其餘14側成人尸體標本按以上參數用導針固定得齣相應Lisfranc韌帶相關數據，作為實驗組，對比兩組測量角度與內側楔骨到第二蹠骨基底長度。②對8例臨床上確認的Lisfranc 損傷患者應用解剖學穫得的參數和定位法行切開複位螺釘置入內固定治療，內固定後隨訪8-14箇月，採用美國足踝外科學會踝-後足評分進行功能評估。結果與結論：①通過解剖觀察得齣，解剖齣的Lisfranc韌帶均為2束。解剖組及實驗組形態學測量結果比較差異無顯著性意義(P>0.05)。為瞭方便臨床應用，作者提齣“Lisfranc通道”這一概唸，將Lisfranc通道定義為內側楔骨(無韌帶區)到第二蹠骨基底部長(31.65±2.23) mm、寬(8.16±1.37) mm、高(1.69±0.21) mm、與內側楔骨近耑成(45.83±6.84)°角、與內側楔骨蹠側成(65.11±4.69)°角的一條通道。通過做囌木精-伊紅染色後，瞭解到Lisfranc韌帶與週圍組織的組織學特性：從層次上分為Lisfranc肌腱、潮線、礦化纖維軟骨、骨等4層結構。②8例Lisfranc損傷患者應用解剖學穫得的參數和定位法進行切開複位內固定後均穫得較高的美國足踝外科學會踝-後足評分，為(80.30±4.85)分。解剖實驗穫得瞭Lisfranc關節及韌帶詳細的形態學參數，為該部位脩複提供瞭解剖學資料，避免盲目置入內固定物，造成Lisfranc韌帶起點的損傷，影響Lisfranc韌帶脩複效果。
배경：척부관절(Lisfranc관절)결구복잡、상규X사선편골관절면중첩，대기진단교곤난。목전대Lisfranc인대적해부학연구교소，결핍상응적형태학자료，도치재상관수복수술중몰유해부위적준학해부삼고치。목적：측량Lisfranc인대적정태은정결구，위Lisfranc관절손상적수복제공림상해부학기출。방법：①대18측성인시체표본진행해부，관찰Lisfranc인대적조직형태병진행측량，득도Lisfranc인대적상세형태삼수，작위해부조，학정Lisfranc인대적주행화골성표지；기여14측성인시체표본안이상삼수용도침고정득출상응Lisfranc인대상관수거，작위실험조，대비량조측량각도여내측설골도제이척골기저장도。②대8례림상상학인적Lisfranc 손상환자응용해부학획득적삼수화정위법행절개복위라정치입내고정치료，내고정후수방8-14개월，채용미국족과외과학회과-후족평분진행공능평고。결과여결론：①통과해부관찰득출，해부출적Lisfranc인대균위2속。해부조급실험조형태학측량결과비교차이무현저성의의(P>0.05)。위료방편림상응용，작자제출“Lisfranc통도”저일개념，장Lisfranc통도정의위내측설골(무인대구)도제이척골기저부장(31.65±2.23) mm、관(8.16±1.37) mm、고(1.69±0.21) mm、여내측설골근단성(45.83±6.84)°각、여내측설골척측성(65.11±4.69)°각적일조통도。통과주소목정-이홍염색후，료해도Lisfranc인대여주위조직적조직학특성：종층차상분위Lisfranc기건、조선、광화섬유연골、골등4층결구。②8례Lisfranc손상환자응용해부학획득적삼수화정위법진행절개복위내고정후균획득교고적미국족과외과학회과-후족평분，위(80.30±4.85)분。해부실험획득료Lisfranc관절급인대상세적형태학삼수，위해부위수복제공료해부학자료，피면맹목치입내고정물，조성Lisfranc인대기점적손상，영향Lisfranc인대수복효과。
BACKGROUND:The Lisfranc joint has a complex structure with bony joint surfaces overlapped on the conventional X-ray film, which is diagnosed difficultly. There are less anatomical studies on the Lisfranc ligament, which leads to no accurate anatomical evidence for the repair of Lisfranc ligament injury. OBJECTIVE: To measure the stable structure of Lisfranc ligament at static state so as to provide anatomical <br> evidence for clinical repair of Lisfranc ligament injury. METHODS:(1) Eighteen adult corpse specimens were dissected to observe the morphology of Lisfranc ligament and measure relevant parameters as anatomical group. In the anatomical group, the traveling trend and bony landmarks were confirmed. Another 14 adult corpse specimens were taken as experimental group to fix the Lisfranc ligament using a guide pin and detect the corresponding Lisfranc ligament data based on the above-mentioned parameters. Measured angle and length from the entocuneiform to the second metatarsal base were compared between the two groups. (2) Eight patients with clinicaly confirmed Lisfranc injury were subject to open reduction and internal fixation surgery based on anatomical parameters and positioning method. Patients were folowed up for 8-14 months, and AOFAS Ankle Hindfoot Scale was used for functional evaluation. RESULTS AND CONCLUSION:The Lisfranc ligament had two bundles. There was no difference in the morphological measurement between the anatomical and experimental groups (P > 0.05). “Lisfranc channel” was proposed by the authors, which was defined as: the length, width and height from the entocuneiform (with no ligament) to the second metatarsal base were (31.65±2.23) mm, (8.16±1.37) mm, (1.69±0.21) mm, respectively, and the angles with the proximal entocuneiform and plantar side of the proximal entocuneiform were (45.83±6.84)° and (65.11±4.69)°, respectively. Hematoxylin-eosin staining showed the histological characteristics of the Lisfranc ligament with the surrounding tissues and there was a four-layer structure: Lisfranc tendons, tide lines, mineralized fibrocartilage and bone. (2) After treatment, the AOFAS Ankle Hindfoot Scale scores were improved to (80.30±4.85) points in the eight patients. Morphological parameters of Lisfranc joint and ligament obtained from anatomical experiments provide anatomical evidence for the repair of Lisfranc injury, and avoid blinded internal fixation that can cause the damage to the starting point of the Lisfranc ligament and impact the restorative effects on Lisfranc injury.