Maisonneuve骨折影像学特点

Imaging Features of Maisonneuve Fracture of the Fibula

目的Maisonneuve骨折(MFF)是一种少见的特殊类型的踝关节损伤。通过回顾性分析MFF患者X线、计算机断层扫描(CT)、磁共振成像(MRI)影像学表现和术中探查结果来描述MFF的病理解剖特征,为其损伤机制和治疗提供影像学依据。方法回顾性分析2015年1月至2021年1月郑州市骨科医院收治的54例MFF患者资料,其中男40例,女14例,年龄18~61(50.45±15.12)岁,左侧26例,右侧28例。54例患者均行患侧踝关节正侧位和胫腓骨正侧位X线检查,42位患者行踝关节三维CT检查,18例患者行踝关节MRI检查。46位患者接受切开复位内固定治疗。记录并分析腓骨近端、踝关节内侧结构、下胫腓联合和后踝结构损伤特点。结果54例患者存在腓骨近端1/3骨折。35例患者存在内踝骨折,16例患者存在三角韧带断裂,3例患者内踝结构完整。54例患者存在下胫腓前韧带损伤。45例患者存在后踝骨折,1例患者存在下胫腓后韧带断裂,8例患者后踝结构完整。结论MFF的特点是腓骨近端骨折和下胫腓前韧带断裂。X线在诊断MFF中具有一定的假阴性率,建议踝关节骨折病人进行体格检查、CT和MRI检查。MFF由外旋力引起,影像学表现不同,对治疗具有重要的指导意义。

Objective Maisonneuve fracture of the fibula(MFF)is a rare special type of ankle injury.The pathological anatomical features of MFF were described by retrospectively analyzing the X-rays,computed tomography(CT),magnetic resonance imaging(MRI)and intraoperative results of patients with MFF,to provide basis for their injury mechanism and treatment.Methods A retrospective analysis was conducted on 54 patients with MFF admitted to Zhengzhou Orthopaedic Hospital from January 2015 to January 2021.There were 40 males and 14 females,with an average age of 18 to 61(50.45±15.12)years old,26 cases of left fractures and 28 cases of right fractures.All 54 patients underwent anteroposterior and lateral X-ray of the ankle and calf,42 patients underwent three-dimensional CT of the ankle joint,and 18 patients underwent ankle MRI.A total of 46 patients received incision reduction and internal fixation.Record and analyze the lesion characteristics of the proximal fibula,medial structure of the ankle joint,distal tibiofibular syndesmosis and posterior ankle structure.Results Fifty-five patients had fractures of the proximal third of the fibula.A total of 35 patients had internal ankle fracture,16 patients had ruptured deltoid ligament,and 3 patients had complete internal ankle structure.There were 54 patients with anterior inferior tibiofibular ligament injury.A total of 45 patients had posterior ankle fracture,1 patient had posterior inferior tibiofibular ligament rupture,and 8 patients had posterior ankle structural integrity.Conclusion MFF is characterized by proximal fibula fracture and rupture of the inferior tibia fibula anterior ligament.X-rays have a certain false-negative rate in the diagnosis of MFF,and it is recommended that patients with ankle fractures undergo physical examination,CT and MRI.MFF is caused by external rotation and has different imaging manifestations,which is of great guiding significance for treatment.