一种特殊类型的Maisonneuve损伤的诊断和治疗  

Diagnosis and surgical treatment of a special type of Maisonneuve injury

作　　者：尹博[1] 周君琳[1] 刘洋[1] 贾佳霖 何远铭 Yin Bo;Zhou Junlin;Liu Yang;Jia Jialin;He Yuanming(Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中华创伤骨科杂志》2021年第2期162-166,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的报道一种特殊类型的Maisonneuve损伤的诊断和治疗效果。方法回顾性分析首都医科大学附属北京朝阳医院骨科自2015年1月至2019年7月收治的4例Maisonneuve损伤患者资料。男3例,女1例;年龄34~61岁,平均45.3岁;患者均为闭合性损伤。所有患者初始X线片表现为踝关节后脱位,手法复位后复查X线及CT显示复位良好无合并踝关节骨折,故急诊漏诊,门诊复查后显示下胫腓联合分离。所有患者均采用恢复腓骨长度、固定下胫腓联合及修复三角韧带的方法治疗。术后12个月采用美国足踝外科协会(AOFAS)的踝-后足评分评价患者术后功能。结果41例患者术后获12~14个月(平均12.7个月)随访。术后骨折愈合时间为110~185 d,平均149.3 d。术后未出现相关并发症,术后12个月AOFAS的踝-后足评分为82~96分(平均90.5分);其中优3例,良1例。结论临床表现为踝关节后脱位且不伴有明显踝关节骨折的Maisonneuve损伤临床上易漏诊,对单纯踝关节后脱位的患者复位后结合体格检查需要拍摄胫腓骨全长X线片明确诊断。一旦确诊,需行手术治疗。通过修复踝关节三角韧带及稳定下胫腓联合的方法可以达到满意的疗效。Objective To report the diagnosis and surgical treatment of a special type of Maisonneuve injury.Methods A total of 4 patients were treated at Department of Orthopaedics,Beijing Chao Yang Hospital from January 2015 to July 2019 for Maisonneuve injury.They were 3 males and one female,aged from 34 to 61 years(average,45.3 years).All injuries were closed,initially manifested as posterior dislocation of the ankle on X-ray films and X-ray and CT re-exams after manual reduction showed fine reduction with no obvious fracture of the ankle joint.Consequently the diagnosis of their Maisonneuve injury was missed in emergency visits,but re-exams in outpatient visits showed separation of distal tibiofibular syndesmosis.All the patients were treated by restoration of the fibular length,fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was used to evaluate functional recovery of the ankle joint at 12 months after operation.Results All the 4 patients were followed up for 12 to 14 months(average,12.7 months).The fractures united after 110 to 185 days(average,149.3 days).No post-operative complications like infection,delayed union or nonunion were observed.The AOFAS score at 12 months ranged from 82 to 96 points(average,90.5 points),giving 3 excellent and one good cases.Conclusions The Maisonneuve injury which is clinically manifested as posterior dislocation of the ankle with no obvious fracture of the ankle joint is likely to be missed in clinical diagnosis.Therefore,X-ray exam of the full length tibia and fibula should be taken in physical examination after reduction for the patients with simple posterior dislocation of the ankle.Once the special type of Maisonneuve injury is diagnosed,surgical treatment is indicated.Satisfactory treatment efficacy can be achieved by fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.

关 键 词：踝关节 脱位 关节不稳定性 Maisonneuve损伤 

分 类 号：R683.42[医药卫生—骨科学]