Maisonneuve骨折临床分析及相关实验研究

Maisonneuve fracture of the fibula:clinical and experimental study

目的探讨Ｍａｉｓｏｎｎｅｕｖｅ骨折（ＭＦＦ）创伤机制及临床治疗方法。方法ＭＦＦ患者１９例，８例行保守治疗，１１行手术治疗；８例术前行ＭＲＩ检查；平均随访时间１６．８个月。另外取新鲜尸体大腿截肢标本进行截骨及骨间膜顺序切断实验，观察踝关节应力像表现。结果（１）踝关节功能恢复情况：１１例手术患者中８例良好，３例可；８例保守治疗患者中３例良好，３例可，２例差。（２）ＭＲＩ检查结果：骨间膜损伤水平均在胫距关节面上３ｃｍ～８ｃｍ，其近端骨间膜保持完整，高位腓骨骨折处骨间膜亦无损伤。（３）尸体标本实验：在人工ＭＦＦ损伤模型中单独固定内踝并不能控制下胫腓分离。结论ＭＦＦ损伤通常发生骨间膜断裂而导致下胫腓分离，但骨间膜断裂的水平与腓骨骨折水平并非一致。上胫腓联合对腓骨外旋的限制及膝关节在损伤时所处的屈曲角度共同参与了高位腓骨骨折的产生。治疗上主张切开复位。

Objective To study the traumatic mechanism and clinical treatment of Maisonneuve fracture. Method 19 of 25 patients (6～60 months,average 16.8 months) were followed up.11 patients were operated on and 8 were treated conservatively. Of the 25 patients,8 had MRI. Osteotomy and serial section of the interosseous membrane(IOM) on fresh cadaveric specimens were doc carried out to observe the diastasis on stress mortise view. Result Functional rehabilitation of the ankle joint: in 11 operative cases, 8 showed good results and 3 fair. In 8 conservative cases, 3 showed good results, 2 fair and 2 poor.MRI: IOM was ruptured in a range 3～8 cm proximal to the tibial plafond in the 8 cases. No IOM rupture was found at the high fibular fracture level. Fresh cadaveric experiment:fixation of the medial side alone can not controll the syndesmotic diastasis on the artificial Maisonneuve fracture model made on cadaveric specimen. Conclusion The injury level of the IOM during Maisonneuve fracture may not be consistent with the high fibular fracture. The limited external rotation of the fibula during injury by the superior tibio fibular syndesmosis comprise to the high level fibular fracture. ORIF with syndesmotic fixation is recommended for the treatment.