马松内夫骨折

Kašper Š, Bartoníček J, Kostlivý K, Malík J, Tuček M

Rozhl Chir. 2020 Winter;99(2):77-85. doi: 10.33699/PIS.2020.99.2.77-85.

INTRODUCTION

Maisonneuve fracture (MF) is a generally known entity in ankle trauma. However, details about this type of injury can be found only rarely in the literature. For these reasons we have decided to perform a study on MF epidemiology and pathoanatomy.

METHODS

The group comprised 70 patients (47 men, 23 women), with the mean age of 48 years, who sustained an ankle fracture-dislocation involving the proximal quarter of the fibula. Ankle radiographs in three views and lower leg radiographs in two views were performed in all patients. A total of 59 patients underwent CT examination in three views, including 3D CT reconstruction in 49 of these patients. MRI was performed in 4 patients. Operative treatment was used in 67 patients; open reduction of the distal fibula into the fibular notch was opted for in 54 of them.

RESULTS

The highest MF incidence rate was recorded in the 5th decade in the whole group and in men, while in women the peak incidence was in the 6th decade. After the age of 50, the share of women significantly increased. In 64 cases, the fibular fracture was subcapital, and in 6 cases it involved the fibular head. In 24% of the patients, the fibular fracture was seen only in the lateral radiograph of the lower leg. Widening of the tibiofibular clear space was shown by radiographs in 40 cases. Posterior dislocation of the fibula (Bosworth fracture) and tibiofibular diastasis were recorded in 2 cases each. An injury to the anterior and posterior tibiofibular ligaments was found in all 54 patients with open reduction of the distal fibula. A fracture of the medial malleolus was identified in 27 cases (39%) and a complete lesion of the deltoid ligament in 36 cases (51%); in 7 cases (10%) the medial structures were intact. A fracture of the posterior malleolus occurred in 54 (77%) patients. Osteochondral fracture of the talar dome was diagnosed in 2 patients and compression of the articular surface of the distal tibia in the region of the fibular notch in 1 patient.

CONCLUSION

Maisonneuve fracture includes a wide range of injuries both to bone and ligamentous structures of the ankle. Therefore, CT examination is an indispensable part of assessment of this type of fracture.

引言

马松纽夫骨折（MF）是踝关节创伤中一种广为人知的损伤类型。然而，关于这类损伤的详细信息在文献中却鲜有记载。基于这些原因，我们决定开展一项关于MF流行病学和病理解剖学的研究。

方法

该研究组包括70例患者（47例男性，23例女性），平均年龄48岁，均发生了累及腓骨近端四分之一的踝关节骨折脱位。所有患者均拍摄了踝关节的三个视图X线片和小腿的两个视图X线片。共有59例患者进行了三个视图的CT检查，其中49例患者进行了三维CT重建。4例患者进行了MRI检查。67例患者接受了手术治疗；其中54例选择了将腓骨远端切开复位至腓骨切迹。

结果

在整个研究组中，MF发病率最高的年龄段为第五个十年，男性也是如此，而女性的发病率高峰在第六个十年。50岁以后，女性的比例显著增加。64例患者的腓骨骨折位于股骨头下，6例累及腓骨头。24%的患者仅在小腿外侧X线片上可见腓骨骨折。40例患者的X线片显示胫腓间隙增宽。腓骨后脱位（博斯沃思骨折）和胫腓分离各有2例。在所有54例接受腓骨远端切开复位的患者中均发现胫腓前、后韧带损伤。27例（39%）患者发现内踝骨折，36例（51%）患者发现三角韧带完全损伤；7例（10%）患者内侧结构完整。54例（77%）患者发生后踝骨折。2例患者诊断为距骨穹窿部骨软骨骨折，1例患者诊断为腓骨切迹区域胫骨远端关节面受压。