摘要
目的分析Maisonneuve骨折(MFF)的误诊原因及防范措施。方法回顾性分析2019年11月—2022年12月收治的曾误诊的MFF 18例的临床资料。结果18例均为单侧踝关节受外旋暴力所致的急性闭合性损伤。5例因踝关节疼痛、肿胀、淤斑、活动受限等症状就诊,5例因三角韧带区域压痛、肿胀和淤斑就诊,8例因踝关节周围区域疼痛明显就诊。经查体及踝关节正侧位X线检查和(或)MRI检查,初步诊断为内踝合并后踝骨折5例、三角韧带断裂5例、踝关节软组织损伤8例。后加行小腿全长正侧位X线或踝关节自重应力位踝穴位X线、踝关节MRI检查确诊为MFF。误诊时间为2~13 d。18例确诊后行手术治疗,术后切口均一期愈合,腓骨长度均恢复,踝关节功能均基本恢复正常。结论MFF临床较少见,早期症状不典型,腓骨近端处疼痛轻微,很难发现腓骨近端损伤或骨折证据,易致早期误诊;临床对以踝关节损伤症状就诊患者应加行胫腓骨全长X线检查或踝关节自重应力位踝穴位X线检查,以避免MFF早期误诊。
Objective To analyze the causes of misdiagnosis and preventive measures of Maisonneuve fracture of the fibula(MFF)in clinical practice.Methods The clinical data of 18 patients with misdiagnosed MFF treated from November 2019 to December 2022 were retrospectively analyzed.Results All the 18 cases had acute closed injury caused by external unilateral rotation of the ankle joint.Five patients presented with ankle pain,swelling,ecchymosis,and limited movement,5 patients with tenderness,swelling,and ecchymosis in the deltoid ligament area,and 8 patients with obvious pain in the periankle area.After physical examination and anterior-lateral X-ray examination and/or MRI examination of the ankle,the initial diagnosis was medial malleolus fracture in 5 cases,deltoid ligament fracture in 5 cases,and soft tissue injury of the ankle in 8 cases.MFF was confirmed by full-length anterolateral X-ray or ankle acupoint X-ray at self-weight stress position of the ankle,ankle MRI examination.The duration of misdiagnosis was 2-13 d.After diagnosis,18 cases underwent surgical treatment.The patients had primary healing,fibula length recovered,and ankle joint function basically returned to normal.Conclusion MFF is relatively rare in clinical practice,with atypical early symptoms and mild pain at the proximal end of the fibula.It is difficult to detect evidence of proximal fibular injury or fracture,which can easily lead to early misdiagnosis.In order to avoid early misdiagnosis of MFF,full length X-ray examination of tibia and fibula or ankle acupoint X-ray examination at self-weight stress position of the ankle should be performed for patients with ankle injury symptoms.
作者
凡军
沙勇
纪亲龙
王少峰
FAN Jun;SHA Yong;JI Qinlong;WANG Shaofeng(Department of Orthopedics,Tinglin Hospital of Jinshan District,Shanghai 201505,China)
出处
《临床误诊误治》
CAS
2023年第10期10-13,共4页
Clinical Misdiagnosis & Mistherapy
关键词
MAISONNEUVE骨折
误诊
内踝骨折
后踝骨折
三角韧带断裂
软组织损伤
磁共振成像
诊断
Maisonneuve fracture of the fibula
Misdiagnosis
Internal ankle fracture
Posterior ankle fracture
Triangular ligament rupture
Soft tissue injury
Magnetic resonance imaging
Diagnosis
