,Bowsworth骨折是由美国David Marsh Bosworth医生于1947年首先报道的特殊类型踝关节骨折、脱位之一。其特点是外旋暴力导致踝关节骨折脱位,伴腓骨近端骨折移位、并交锁于胫骨后嵴处。因骨间膜、韧带及腓骨肌腱被拉紧,闭合手法复位比较困难,常需手术切开复位,多次闭合复位将加重软组织损伤和术后疤痕。早期并发症注意骨筋膜室综合症,晚期并发症注意OA,距骨坏死,踝关节运动受限等。 35岁男性,1米高梯子摔落致右踝损伤,影像学提示Bowsworth骨折,腓骨Weber B型骨折。 Fig. 1. Post-injury radiograph showing tibiofibular overlap, posterior subluxation of the talus and a small displaced fragment of the posterior malleolus. 尝试手法闭合复位,胫距关节复位,但胫腓关节无法复位。 Fig. 2. Radiograph after closed reduction, with persis- tively, showed a persisting slight edema, with a ting tibiofibular overlap and marked tibiofibular dissociation in the lateral view. 予以手术治疗,切开撬拨解剖复位后,内固定。胫腓前韧带完整(大部分病例断裂),后踝为Bartonı´cˇek-Rammelt I型骨折,未予固定;复位后稳定,未予修复三角韧带。术后石膏固定6周。 Fig. 3. Postoperative radiograph showing anatomical reduction, with the exception of the posterior malleolus fragment. 术后1年随访 术后13年随访 CT reconstructions confirming anatomical reduction. Posterior view on 3D CT reconstruction shows a defect following marginal impaction of the posterior malleolus lateral to the malleolar groove but outside the fibular notch (yellow arrow). |
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