Maisonneuve骨折的手术治疗△

Surgical treatment of Maisonneuve fractures

摘要:

［目的］ 探讨 Maisonneuve 骨折的手术技巧及临床效果。［方法］ 回顾性分析本科于 2017 年 9 月—2020 年 6 月手术治疗 13 例 Maisonnouve 骨折患者的临床资料，所有患者均合并腓骨上段骨折、内踝和后踝骨折及下胫腓联合分离。评估临床及影像结果。［结果］13 例患者均顺利完成手术，均未固定腓骨近端骨折，下胫腓联合均为 2 枚空心螺钉 3 层皮质固定，所有患者术中无神经、血管损伤等严重并发症。随访时间平均（21.7±8.0）个月，随术后时间推移，踝背伸-跖屈活动度（ROMs）、AO- FAS、Olerud-Molander 评分均显著增加（P<0.05），但踝关节内-外翻 ROM 无明显改变（P>0.05）。影像方面，所有患者均达到满意骨折复位。随术后时间推移，TTA 、踝总体对位对线、踝退变 Morrey-Wiedeman 评级的无显著变化（P>0.05）。［结论］采用直视下复位下胫腓联合的方法可有效恢复腓骨长度及旋转，术后疗效满意。

Abstract:

[Objective] To investigate the surgical technique and clinical outcome of Maisonneuve fractures. [Methods] A retrospective study was conducted on a total of 13 patients who were surgically treated for Maisonneuve fractures in our department from September 2017 to June 2020. All patients suffered from upper fibular fracture, medial malleolus and posterior malleolus fractures, and separation of the infe- rior tibiofibular syndesmosis. Clinical and imaging findings were evaluated. [Results] All the 13 patients had operation performed successful- ly without fixation of the proximal fibula fracture, whereas with inferior tibiofibular syndesmosis fixed by 2 screws through 3 layers of cortex. No serious complications, such as neurovascular injury, happened in anyone of them during the operation. As time went in follow-up lasted for (21.7±8.0) months on average, the dorsal extension- plantar flexion range of motion (ROM) , AOFAS and Olerud-Molander score in- creased significantly (P＜0.05) , but the varus-valgus ROM remained unchanged (P＞0.05) . Radiographically, satisfactory fracture reduction was achieved in all patients, and no significant changes in TTA, overall ankle alignment, and Morrey-Wiedeman grade of ankle degeneration were noted over time postoperatively (P＞0.05) . [Conclusion] The reduction of the inferior tibiofibular syndesmosis under direct vision does effectively restore the length and rotation of the fibula, and get satisfactory clinical outcomes for Maisonneuve fractures.