手术-Lisfranc损伤复位内固定术.docx

1.1、一般考虑???General considerationsORIF is preferred to closed reduction and percutaneous fixation.Screw fixation is preferred to K-wire fixation.内固定最好选择闭合复位经皮固定，螺钉固定效果好于克氏针固定1.2、解剖及功能机制? ? ? ? The Lisfranc / tarsometatarsal (TMT) articulation is very strong. The base of the second metatarsal is held in place by the plantar TMT ligaments.? ? ? ?The significance is that motion at the base of the second metatarsal is restricted. This leads to fractures at the base of the second metatarsal. Unlike other areas with their “essential” joints, the midfoot area joints are not “essential” and therefore motion can be sacrificed to obtain stability and function. The 1, 2 and 3 TMT joints can in fact be fused for acute purely ligamentous injuries. The 4 and 5 TMT joints should be stabilized with K-wires as some retained motion in this area is helpful for better function, because normally there is motion between the 4th and 5th metatarsal and the cuboid.As a result, when treating fractures in the Lisfranc / midfoot area, joint surface reconstruction may not be as critical as in other joints.? ? ?Lisfranc关节非常强壮，第2跖骨基底靠跖跗关节韧带加强。其意义是第2跖骨基底被限制在此，这导致了它骨折的风险。不像其他部位的关节必须保留，中足关节活动可以牺牲以便获得稳定和功能。第1、2,3跖跗关节可以融合以治疗纯粹急性韧带损伤；第4和第5跖跗关节应该通过克氏针保持稳定，保留其活动对于整体功能有帮助的，因为在第4和第5跖骨和骰骨间有轻微活动。因此在治疗?Lisfranc损伤或中足其它损伤，关节面重建不是那么重要了。2、手术入路??背侧平行双入路结合内侧维持入路Dorsal double parallel and medial mini approachIn the forefoot, incisions should be straight, in the axis of the foot and should never be undermined.The dorsomedial incision is centered over the TMT area, between the extensor hallucislongus tendon (EHL) and extensor hallucisbrevis (EHB). This incision allows access to the first TMT and the medial base of the 2nd TMT.The dorsolateral incision is centered over the TMT area, roughly in line with the fourth metatarsal.?A skin bridge as wide as possible should be maintained. But, as long as the area between the incisions is not undermined, the skin bridge is not compromised.A third small medial incision (along the