Maisonneuve损伤是指踝关节内侧结构损伤+下胫腓联合损伤+腓骨近端骨折。有学者提出Maisonneuve-Equivalent损伤包括内踝结构完整的情况下腓骨近端骨折和下胫腓联合损伤；或者腓骨完整的情况下，下胫腓联合损伤和近端胫腓关节脱位。近期有学者提出另外一种Maisonneuve-Equivalent损伤即胫骨平台外侧劈裂压缩骨折+胫腓骨骨间膜，下胫腓联合损伤，但腓骨和内踝结构完整。（http://dx.doi.org/10.2106/JBJS.CC.19.00280）
44岁男性，车祸后致右下肢疼痛、活动受限。既往有静脉性皮炎。
影像学提示胫骨平台骨折，腓骨完整，下胫腓未见损伤；患者诉下胫腓联合处疼痛，完善踝穴位后显示下胫腓联合损伤。进一步CT检查未发现腓骨骨折。
Fig. 2 Anteroposterior (AP) and lateral right knee radiographs demonstrating a lateral split/depressed tibial plateau fracture with posterior coronally oriented fragment (left 2 images); AP right tibia and fibula demonstrating tibial plateau fracture as above, with intact fibula and without apparent syndesmotic injury (middle); lateral and mortise radiographs of the right ankle with subtle anterior displacement of fibula relative to tibia on the lateral view and with gross diastasis at the distal syndesmosis on the mortise view (right 2 images).
Fig. 3 Axial computed tomography (CT) cut at the tibial plateau demonstrating the lateral cortical split with lateral depression and a coronally oriented fracture with bicondylar extension (left), coronal CT cut demonstrating the lateral cortical split and depressed portion of the lateral tibial plateau (second from left), and sagittal CT cut demonstrating the coronally oriented fracture line (middle). The right 2 images represent coronal and sagittal CT cuts of the proximal fibula, confirming the absence of fracture。
术中胫骨平台采用前外侧入路，开窗复位平台高度后克氏针固定，前后两颗螺钉固定平台后方骨块，外侧L型接骨板固定胫骨平台；下胫腓联合采用3孔三分之一管型结合两枚3.5mm螺钉固定。
Fig. 4 Six-month postoperative anteroposterior and lateral radiographs of the right knee (left) and mortise and lateral views of the ankle (right).
踝穴位评价下胫腓联合损伤的敏感性优于踝关节正侧位。此例患者作者考虑到局部皮肤条件差的原因，所以未另做切口在后方上butress plate；固定下胫腓可以使用螺钉或tightrope，但tightrope对于同时有下肢远近端损伤的患者不能提供轴向稳定；
Maisonneuve损伤通常发生于踝关节外旋，距骨向外旋传导力至腓骨引起下胫腓联合和骨间膜损伤，进而向上传导引起腓骨近端骨折；胫骨平台骨折通常是由轴向合并内翻或外翻暴力引起，所以发生在本例患者有可能是单纯轴向暴力引起胫骨平台骨折，继续向下传导引起骨间膜和下胫腓损伤。
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