这些特殊类型的骨折你都能诊断吗？

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Bosworth 骨折

Bosworth 骨折是指踝关节骨折脱位，腓骨近端骨折段向胫骨后面移位并交锁于胫骨后面，此类骨折是由于踝关节遭受外旋暴力时，腓骨脱位至胫骨后面，然后再骨折，近端骨折段受阻于胫骨后嵴处。

由于骨间膜和韧带紧张，腓骨肌腱被拉紧，腓骨近侧骨折段绞锁于胫骨后面。这类骨折通常闭合复位失败，需要切开复位内固定。

Logsplitter 骨折

Logsplitter 骨折又称为劈木机损伤、经下胫腓联合踝关节骨折脱位，是一种特殊类型的踝关节骨折，主要是指以高能量垂直暴力为主、多种暴力复合所致的踝关节骨折，合并距骨向上楔入下胫腓联合而导致下胫腓联合分离，可合并腓骨骨折、内踝骨折或三角韧带断裂，踝关节完全脱位，可伴有胫骨「天花板」骨折和（或）距骨骨折。

Dupuytren 骨折

1800 年，法国医生 Dafon Guillaume Dupuytren  首先注意到踝部骨折伴下胫腓联合分离。

Dupuytren 骨折可分为高位型和低位型 2 个类型∶

1、高位 Dupuytren 骨折（腓骨骨折位于下胫腓联合上方 6.5 ~ 7.5 cm）

是踝部遭受外展暴力的结果，腓骨在下胫腓联合近侧骨折，伴有下胫腓联合的撕裂、骨间膜撕裂、内踝骨折或三角韧带损伤，同时距骨在踝穴内向外脱位。

2、低位 Dupuytren 骨折（腓骨骨折位于下胫腓联合处骨折）

是踝部遭受外旋暴力的结果，腓骨在下胫腓联合处骨折，伴下胫腓联合前韧带撕裂、内踝骨折或三角韧带断裂。

Pott 骨折

腓骨远端（5 ~ 7.5 cm）的骨折，远端腓骨骨折端向内侧移位且紧贴胫骨，外踝向外上移位，同时伴有内踝骨折或三角韧带断裂，踝关节发生半脱位（距骨向外脱位），内踝处有时可能出现皮肤破损。

Wagstaffe（Lefort）骨折

又称为 Le Fort-Wagstaffe 骨折，是指外踝前缘的垂直（纵行）骨折，认为是下胫腓前韧带在腓骨的附着点处发生的撕脱骨折，骨折块称为 Wagstaffe 骨块。（该骨折一般见于旋后外旋型、旋前外展型）

Wagstaffe 骨折可分为 3 型：

1、I 型（原发性 Wagstaffe 骨折）

是下胫腓前韧带在腓骨附着点的骨片撕脱骨折。

2、Ⅱ型（继发性 Wagstaffe 骨折）

是腓骨于下胫腓前韧带附着点以下斜形骨折，伴有下胫腓前韧带在腓骨附着点骨折，Wagstaffe  认为由距骨撞击产生，最常见的机制是旋后-外旋型。（最常见的类型）

3、Ⅲ型

Ⅲ型是腓骨骨折时伴有下胫腓前韧带胫骨的止点处发生的撕脱骨折（即  Chaput 骨折）。

Tillaux 骨折

Tillaux 骨折又称为Chaput 骨折、Tillaux-Chaput 骨折，是指下胫腓联合前韧带在胫骨的附着点处发生的撕脱骨折。

该骨折常在踝穴片显示，或在摄踝关节内旋 45° 正位片中显示，骨折块称为 Chaput 骨块。   

Volkmann 骨折

Volkmann 骨折亦称后踝骨折，是下胫腓后韧带在胫骨的止点处发生的撕脱骨折。该骨折块称为 Volkmann 骨块。（该骨折一般见于旋后外旋型 III 型 IV 型、旋前外旋型 IV 型）

1、骨折为外侧撕脱不带关节面

2、骨折为带部分后踝关节面

Cotton 骨折

1915 年，Frederic Cotton 在内外踝骨折的基础上强调了胫骨后唇关节面骨折的特征，踝关节向后脱位。1932 年，Hendersen 称此为三踝骨折。其特征是胫骨远端关节面后缘的骨折伴距骨向后脱位。

Maisonneuve 骨折

Maisonneuve 是 Dupuytren 的学生，认识到当外旋暴力导致踝关节损伤时，如下胫腓联合韧带断裂，暴力可引起腓骨近端或解剖颈骨折，骨折线常呈螺旋形，并可伴踝关节内侧损伤。

Maisonneuve 骨折约占踝部损伤的 1% ~ 11%，其特点是腓骨近端 1/3 螺旋形骨折伴下胫腓联合损伤、骨间膜撕裂、内踝骨折或三角韧带撕裂，常合并距腓前韧带断裂以及后踝骨折等。

在这类损伤中如果内侧结构损伤是三角韧带断裂，同时下胫腓全部韧带损伤，而从 X 线片上仅可见到腓骨中上 1/3 骨折，甚或腓骨颈骨折或上胫腓分离，此时不应忽略踝关节损伤与下胫腓分离存在的重要性，我们在临床中应高度重视此情况的发生。

这类骨折是不稳定的骨折，需要用下胫腓位置螺钉固定下胫腓关节 8 ～ 12 周。（该骨折一般见于旋前外旋型 III 型、IV 型）

作者：孙小六

排版：景胜杰

投稿：[e-mail]

参考文献(特别多)

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26 解放军总医院创伤骨科手术学

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