不同类型Maisonneuve骨折的影像解剖学特征和损伤机制  

Imaging anatomic features and injury mechanism of Maisonneuve fractures with different clinical manifestations

作　　者：李晓亮 孙培锋 刘红国 夏国峰 LI Xiaoliang;SUN Peifeng;LIU Hongguo;XIA Guofeng(Department of Orthopedics,No.971 Hospital of PLA Navy,Qingdao 266071,China)

机构地区：[1]海军第971医院骨科,青岛266071

出　　处：《武警医学》2024年第12期1024-1027,1031,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：青岛市卫健委医药科研指导计划项目(2020-wjzd191)

摘　　要：目的 探讨不同类型Maisonneuve骨折的影像解剖学特征和损伤机制。方法 回顾性分析2017-01至2024-01海军第971医院收治的37例Maisonneuve骨折患者临床资料。所有患者均接受了踝关节、胫腓骨全长的正侧位X线检查,36例接受了踝关节CT扫描、26例接受了踝关节MRI检查。记录并分析腓骨近端骨折、踝关节内侧、后踝结构损伤、下胫腓前韧带和骨间膜损伤情况。结果 37例患者均腓骨近端1/3骨折,其中5例(13.51%)腓骨颈骨折,29例(78.38%)腓骨近端1/3骨折,3例(8.11%)为腓骨干中、上1/3交界处骨折。32例(86.49%)发生后踝结构损伤,其中后踝骨折31例(83.78%),下胫腓后韧带断裂1例(2.70%)。37例均存在下胫腓前韧带损伤,其中1例下胫腓前韧带断裂、腓骨近端和后踝骨折,但内踝结构完整。36例致伤机制为Lauge-Hanson分类旋前-外旋型损伤,1例为旋后-外旋型。结论 腓骨近端骨折和下胫腓前韧带断裂是Maisonneuve骨折的基本特征,旋前-外旋是主要的损伤机制。术前诊断应充分考虑X线检查的局限性,结合CT或MRI对患者谨慎诊断以避免漏诊。Objective To investigate the imaging anatomic features and injury mechanisms of different types of Maisonneuve fractures.Methods The clinical data of 37 patients with Maisonneuve fractures admitted to No.971 Hospital of PLA Navy from January 2017 to January 2024 were retrospectively analyzed.All patients underwent anteroposterior and lateral X-ray examination of the full length of the ankle joint,tibia and fibula,36 patients underwent ankle CT scan and 26 patients underwent MRI of the ankle joint.The proximal fibula fractures,medial and posterior ankle structural injuries,anterior tibiofibular ligament and interosseous membrane injuries were recorded and analyzed.Results All the 37 patients suffered from proximal fibula fractures,including 5 cases(13.51%)of fibular neck fractures,29 cases(78.38%)of proximal fibula fractures,and 3 cases(8.11%)of fractures at the junction of the middle and upper 1/3 of the fibula shaft.There were 32 patients(86.49%)with posterior ankle structural injuries,including 31 cases(83.78%)of posterior ankle fractures and 1 case(2.70%)with inferior posterior tibiofibular ligament fracture.All 37 patients had anterior tibiofibular ligament injuries,including 1 case of anterior tibiofibular ligament rupture and proximal fibula and posterior ankle fractures,but the medial ankle structure was intact.The injury mechanism of 36 cases was Lauge-Hanson classification of pronation-external rotation,and 1 case was supination-external rotation.Conclusions Proximal fibula fracture and anterior inferior tibiofibular ligament ruptures are the basic features of Maisonneuve fractures,and pronation-external rotation is the main mechanism of injury.Preoperative diagnosis should fully consider the limitations of X-ray examination,and patients should be carefully diagnosed with CT or MRI to avoid missed diagnosis.

关 键 词：MAISONNEUVE骨折 致伤机制 腓骨 踝关节 

分 类 号：R683.42[医药卫生—骨科学]