Bosworth骨折由美国医生David Marsh Bosworth于1947年首先报道，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、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。为少见的踝关节骨折脱位。

Bosworth骨折通常伴有外踝下胫腓韧带水平的骨折，腓骨交锁、脱位后，外旋暴力是否持续导致后踝骨折？而后踝骨折的存在与否，则与踝关节骨折预后息息相关。

为此，有学者汇报了一组Bosworth骨折病例，并回顾相关文献，以研究Bosworth骨折合并后踝骨折的几率。

Objectives（目的）

 

后踝骨折与踝关节骨折的不良预后有关。本研究旨在分析Bosworth骨折脱位中后踝骨折的发生率及病理解剖。

[Objectives: Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracturedislocations (BF).]

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Material and Methods（病例与方法）

对13例在我院接受治疗的患者和97例在1947年至2018年间发表的病例的X线片和CT断层扫描进行了系统的文献检索，并根据后踝骨折的病理解剖进行了评估。在本研究的13例病例和10例文献中病例，均进行了轴向CT扫描。

图1 典型Bosworth骨折病例。

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图2 移位的腓骨骨折合并无移位的后踝骨折。

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图3 移位的腓骨骨块位于胫骨后侧与后踝骨块之间。

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图4 图1X线平片患者的三维重建。可见后踝骨块向内侧延伸。

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[Materials and Methods: Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF. In all 13 cases from the present study and in 10 cases from the literature, axial CT scans were performed.]

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Results（结果）

本系列的所有13名Bosworth骨折患者(100%)和文献记载的97例中的61例(63%)均与后踝骨折相关。在有完整CT分析的患者中，胫骨后缘后腓骨脱位与切迹外(bartony cek/Rammelt 1型)后踝骨折相关。移位的后踝骨块和胫骨之间的腓骨移位与bartony cek/Rammelt 2型和3型后踝骨折相关。

[Results: All 13 patients (100%) with BF from the present series and 61 of 97 documented cases (63%) of BF from the literature were associated with a PM fracture. In patients with a complete CT analysis, dislocation of the fibula behind the posterior tibial rim was associated with extraincisural (Bartonícek ˇ / Rammelt type 1) PM fracures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartonícek ˇ / Rammelt types 2 and 3 PM fractures.]

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Conclusion（结论）

所有报道的Bosworth骨折中有70例与后踝骨折有关。真正的发生率可能更高，因为历史上很少使用CT成像。后踝骨块的病理解剖是高度可变的，就像Bosworth骨折中腓骨移位的类型一样。因此，Bosworth骨折应常规进行CT扫描。Bosworth骨折移位的后踝骨折累及切迹，应通过直接后外侧入路进行手术治疗。 [Conclusion: Seventy prevent of all reported BF are associated with a PM fracture. The true prevalence may be even higher because of the historically infrequent use of CT imaging. The pathoanatomy of the PM fragment is highly variable as is the kind of fibular displacement in BF. Therefore, CT scanning should be performed routinely in BF. Displaced PM fractures in BF involving the incisura should be treated operatively via a direct posterolateral approach.]