第5跖骨骨折(Jones Fracture)

原创 马明医生  2019-07-13

来自专辑

下肢骨折

A British surgeon named Sir Robert Jones sustained an acute fracture at the base of the fifth metatarsal bone while dancing. This then prompted the Jones fracture to be named after him.

一位名叫罗伯特琼斯爵士的英国外科医生在跳舞时第五跖骨底部发生了急性骨折。这促使琼斯骨折以他的名字命名。

Jones fractures occur at the metaphyseal/diaphyseal junction. The fracture extends into the intermetatarsal joint proximal to the metatarsocuboid joint. The intermetatarsal joint articulates with the fourth metatarsal and the metatarsocuboid joint articulates with the cuboid bone. In order for the Jones fracture to be called so, the fracture must enter the intermetatarsal joint, which means the fracture must also be distal to the metatarsaocuboid joint.

琼斯骨折发生在干骺端/骨干端交界处。骨折延伸至跖间关节、跖骰关节、第四跖关节与骰骨。琼斯骨折：骨折必须进入跖间关节，这就意味着骨折也必须累及跖骨关节远端。

Jones fractures occur about 1.5 cm distal to the tuberosity of the fifth metatarsal bone. This metatarsal bone is divided into the head, the neck, the shaft, and the tuberosity. Jones fractures of the proximal fifth metatarsal occurs in the watershed area within 1.5 cm of the tuberosity. This means that the fracture occurs in an area of limited blood supply. There are multiple metaphyseal arteries in the tuberosity. There is also a nutrient artery with intramedullary branches that provides retrograde blood flow to the proximal fifth metatarsal. Therefore, a fracture distal to the tuberosity will disrupt the nutrient artery supply, resulting in relative avascularity.

琼斯骨折发生在第五跖骨结节远端约1.5厘米处。跖骨分为头、颈、干和结节。第五跖骨近端琼斯骨折发生在距结节1.5 cm的分水岭区。这意味着骨折发生在血液供应有限的区域。结节内可见多条干骺动脉，还有一条营养动脉与髓内分支，提供逆向血流到第五跖骨。因此，结节远端骨折会破坏营养动脉供应，导致相对缺血。

The peroneus tertius tendon is inserted into the dorsal metaphysis of the fifth metatarsal bone. Then, the peroneus brevis tendon is inserted into the tuberosity of the fifth metatarsal bone. The plantar fascia is also connected to the fifth metatarsal bone. Therefore, when a Jones fracture occurs, the tendons will pull the fracture apart, which will prevent healing.

第三腓骨肌腱止于第五跖骨背侧干骺端，腓骨短肌腱止于第五跖骨结节。足底筋膜也与第五跖骨相连。因此，当发生琼斯骨折时，肌腱会将骨折拉开移位影响愈合。

There are three types of fractures at the proximal fifth metatarsal. A fracture in zone I is called a tuberosity avulsion fracture. A fracture in zone II is called a Jones fracture. Finally, a fracture in zone III is usually a stress fracture. A fracture in zone I is also called a pseudo Jones fracture. It is located at the peroneus brevis insertion site, and is usually treated with conservative treatment. Zone II Jones fractures occur at the metaphyseal-diaphyseal junction, and involve the fourth and fifth metatarsal articulation. Zone III stress fractures are chronic fractures that occur distal to the fourth and fifth metatarsal articulation, and may be associated with cavovarus foot deformity.

第五跖骨骨折有三种类型。I区骨折称为结节性撕脱骨折。II区的骨折称为琼斯骨折，III区骨折通常为应力骨折。I区的骨折也称为假琼斯裂缝。它位于腓骨短肌止点部位，通常采用保守治疗。II区Jones骨折发生于干骺端-骨干交界处，累及第四和第五跖关节。III区应力性骨折是发生在第四和第五跖骨关节远端的慢性骨折，可能与足部的高弓外翻足畸形有关。

It is important to not make the wrong diagnosis of the proximal fifth metatarsal base in children while looking at a normal growth plate. This is usually present between the ages of 9–14 years of age and is parallel and lateral to the metatarsal.

重要的是不要对儿童近端第五跖骨基底部正常生长板做出错误的诊断。这种情况通常发生在9-14岁之间，与跖骨平行或稍侧。

X-rays will show the fracture and its location. An acute Jones Fracture will have sharp margins with no intramedullary sclerosis. On the other hand, a stress fracture will have a wide fracture line with medullary sclerosis.

X线能显示骨折及其位置。急性琼斯骨折边缘锐利，无髓内硬化。另外，应力性骨折在髓质硬化时骨折线较宽。