下胫腓联合螺钉治疗Maisonneuve骨折的疗效  

Fixation of inferior tibiofibular syndesmosis by screw for Maisonneuve fracture

作　　者：叶秀章[1,2] 施继飞[1,2] 敖荣广[1,2] 丁惠锋[1,2] 周成欢 禹宝庆[1,2] 

机构地区：[1]上海市浦东医院 [2]复旦大学附属上海浦东医院骨科,上海201399

出　　处：《中国骨与关节外科》2014年第6期506-509,共4页Chinese Journal of Bone and Joint Surgery

基　　金：浦东新区卫生系统重点学科群建设资助(PWZxq2014-03)

摘　　要：背景：Maisonneuve骨折临床上十分少见,如果处理不当可导致踝关节不稳定。目的：探讨Maisonneuve骨折的损伤机制、诊断、治疗及临床治疗效果。方法方法：回顾性分析2009年8月至2012年10月,手术治疗Maisonneuve骨折19例,男15例,女4例;年龄30-68岁,平均42.2岁。骨折均为Lauge-Hansen旋前外旋型,其中Ⅱ度损伤5例,Ⅲ度损伤6例,Ⅳ度损伤8例。手术均采用2枚皮质骨位置螺钉,三层皮质平行踝关节面固定下胫腓联合韧带。随访时采用AOFAS评分评估踝关节功能恢复情况。结果：19例患者均获随访,随访时间6-65个月,平均50个月,骨折均愈合。末次随访时AOFAS评分平均94.7分（75-97分）,其中优15例,良4例。结论：Maisonneuve骨折是一种严重的不稳定性踝关节骨折,由于其骨折的特殊性,易致误诊及漏诊。手术治疗可恢复下胫腓关节的正常解剖关系以及踝穴的匹配,对预后起决定作用。Background： The Maisonneuve fracture is rare in clinic, and improper management can lead to instability in the ankle.Objective： To explore the injury mechanism, diagnosis and treatment of Maisonneuve fracture.Methods： A retrospective analysis was done in 19 patients who suffered from Maisonneuve fracture and were treated between August 2009 and October 2012. There were 15 males and 4 females with a mean age of 42.2 years（range, 30- 68years）. According to Lauge-Hansen classification, there were 5 cases with grade Ⅱ pronate-extorsion injury, 6 with gradeⅢ pronate-extorsion injury and 8 with grade Ⅳ pronate-extorsion injury.All fractures were fixed with 2 cortical positioning screws. All screws engaged 3 cortices above the ankle joint and parallel to the tibial plafond. AOFAS score was used to evaluate ankle joint function during follow up.Results： All the patients were followed up for 50 months on average（range, 6-65 months）. Bony union was achieved in all fractures. The mean AOFAS score was 94.7（range, 75-97） at the last follow-up. There were 15 patients with excellent outcome and 4 with good results.Conclusions： The Maisonneuve fracture is an unstable fracture that can be easily overlooked in the evaluation of the injured ankle. A mortise in anatomic alignment is the aim of operation.

关 键 词：下胫腓分离 腓骨近端骨折 皮质骨位置钉 

分 类 号：R687.3[医药卫生—骨科学]