Maisonneuve骨折30例误漏诊分析

Analysis of Misdiagnosis and Missed diagnosis of 30 Cases of Maisonneuve Fracture

目的探讨Maisonneuve骨折的临床特点、误漏诊原因以及避免误漏诊的措施。方法对2016年9月—2021年9月曾误漏诊的Maisonneuve骨折30例的临床资料进行回顾性分析。结果本组30例均因暴力外伤导致踝关节疼痛就诊,行踝关节正侧位X线片及体格检查后,17例误漏诊为内踝骨折,4例误漏诊为内踝合并后踝骨折,3例误漏诊为三角韧带断裂,6例误漏诊为踝关节软组织损伤。误漏诊时间3~14(7.94±4.12)d。21例经X线和CT检查确诊为Maisonneuve骨折,行钢板螺钉内固定手术治疗,9例经X线和MRI检查确诊为Maisonneuve骨折,行韧带缝合修补和踝关节支具外固定治疗。30例治疗后均随访1年,术后无踝关节疼痛、肿胀及踝关节炎发生,踝关节活动度与对侧基本相同,X线片示骨折均全部愈合,愈合时间为3.0~6.0(4.36±0.96)个月。治疗后1年美国足踝外科协会踝与后足功能评分优良率为100%;Baird-Jackson功能评分优良率为90%。结论Maisonneuve骨折由于各种原因在临床诊断中容易误漏诊。临床上对于发生踝关节损伤特别是属于Lauge-Hansen分型为旋前-外旋型损伤或伴有下胫腓联合损伤的患者,在查体时应特别注意对小腿全长进行触诊并完善踝穴位和小腿全长正侧位X线片,以避免Maisonneuve骨折误漏诊的发生。

Objective To investigate the clinical features,causes of misdiagnosis and missed diagnosis and measures to avoid misdiagnosis and missed diagnosis of Maisonneuve fracture.Methods The clinical data of 30 patients with Maisonneuve fracture that was misdiagnosed or missed from September 2016 to September 2021 were retrospectively analyzed.Results In this group,all 30 patients were treated for ankle pain caused by violent trauma.After anteroposteric and lateral ankle radiographs and physical examination,there was misdiagnosis or missed diagnosis of medial malleolus fracture in 17 cases,medial malleolus combined with posterior malleolus fracture in 4 cases,deltoid ligament rupture in 3 cases,and ankle soft tissue injury in 6 cases.The time of misdiagnosis ranged from 3-14(7.94±4.12)d.Twenty-one patients were diagnosed with Maisonneuve fracture by X-ray and CT examination,and were treated with plate screw internal fixation;9 patients were diagnosed with Maisonneuve fracture by X-ray and MRI examination,and were treated with ligament suture repair and ankle brace external fixation.All the 30 patients were followed up for 1 year after treatment,and no ankle pain,swelling or ankle arthritis occurred after surgery.The ankle motion was basically the same as that on the opposite side.X-ray films showed that all the fractures were healed,and the healing time was 3.0-6.0(4.36±0.96)months.The excellent and good rate of the American Society for Foot and Ankle Surgery's ankle and hindfoot function score was 100%at one year after treatment,and the Baird-Jackson functional score has an excellent rate of 90%.Conclusion Maisonneuve fracture is more likely to be misdiagnosed in clinical diagnosis for various reasons.In clinical practice,for the patients with ankle joint injury,especially the Lauge Hansen type of pronation-external rotation injury or the patients with syndesmosis injury,special attention should be paid to palpation of the full length of the calf during physical examination and improvement of the ankle acupoint and the full length of the calf antero-lateral radiographs,so as to avoid misdiagnosis and missed diagnosis of Maisonneuve fracture.