Michelson J, Solocoff D, Waldman B, Kendell K, Ahn U
Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Clin Orthop Relat Res. 1997 Dec(345):198-205.
Rational treatment of ankle fractures requires knowledge of the extent of bone and soft tissue injury. Although the Lauge-Hansen classification attempts to do this by relating specific fracture patterns to injury mechanism, the experimental underpinning for this classification has not been reexamined rigorously using modern experimental methods. This study examines the hypothesis that the clinically occurring supination and external rotation injury pattern does not result from the mechanism described by Lauge-Hansen. Thirty-two anatomic specimen ankles were mounted on an MTS machine for combined axial loading with external rotation to failure testing. A foot plate supinated the foot 25 degrees. Testing was performed with the ankle at neutral, 25 degrees plantar flexed, 10 degrees to 15 degrees dorsiflexed, and in 6 degrees to 8 degrees leg valgus. Pure supination and external rotation with the ankle in neutral did not result in the Lauge-Hansen supination and external rotation type fractures. This outcome was not altered if the ankle specimens initially were placed in plantar flexion or dorsiflexion. The addition of a valgus load, which pushes the talus laterally against the fibula, resulted in the classic Lauge-Hansen supination and external rotation type fracture. All specimens had an isolated lateral injury or a lateral injury that preceded medial injury.
踝关节骨折的合理治疗需要了解骨与软组织损伤的程度。尽管Lauge-Hansen分类法试图通过将特定骨折类型与损伤机制相关联来做到这一点，但尚未使用现代实验方法对该分类法的实验基础进行严格重新审视。本研究检验了以下假设：临床上出现的旋后-外旋损伤模式并非由Lauge-Hansen所描述的机制导致。将32个踝关节解剖标本安装在MTS机器上，进行轴向加载与外旋直至破坏测试。一个足板使足部旋后25度。测试在踝关节处于中立位、跖屈25度、背屈10度至15度以及小腿外翻6度至8度的情况下进行。踝关节处于中立位时单纯旋后和外旋并未导致Lauge-Hansen旋后-外旋型骨折。如果踝关节标本最初处于跖屈或背屈位，这一结果并未改变。增加一个外翻负荷，即把距骨向外侧推向腓骨，会导致典型的Lauge-Hansen旋后-外旋型骨折。所有标本均有孤立的外侧损伤或先于内侧损伤的外侧损伤。
