摘要
目的提出后踝骨折新分型系统,进一步阐明后踝骨折的病理解剖学特征。方法选择20例形态正常的下肢新鲜冰冻尸体标本,解剖并测量后踝相关联韧带胫骨附着区的范围。采用回顾性病例系列研究分析2012年1月至2020年7月同济大学附属同济医院及2018年1月至2020年7月克拉玛依市中心医院共收治的296例后踝骨折患者的临床及CT影像学资料,并测量患者后踝骨折占关节面百分比、后踝骨折向近端移位程度及距骨向后脱位程度。将后踝韧带结构解剖测量值与后踝骨折的CT影像学特征相关联,结合后踝韧带结构、后踝骨折块的形态学特征及损伤机制创建后踝骨折新分型系统。共分为3型:Ⅰ型为下胫腓横韧带胫骨附着区骨折;Ⅱ型为下胫腓横韧带及下胫腓后韧带胫骨附着区骨折,依据后踝骨折是否伴有关节软骨及软骨下骨损伤、压缩或Die-Punch骨块可分为ⅡA和ⅡB两个亚型;Ⅲ型为下胫腓横韧带、下胫腓后韧带及胫距后韧带胫骨附着区骨折,按照后踝骨折块数目分为ⅢA和ⅢB两个亚型。观察后踝各韧带结构胫骨附着区的尸体解剖学特征、后踝骨折CT成像的影像学参数及对应分型情况。同时,将后踝骨折新分型与Haraguci分型及Mason分型相对比。结果后踝韧带结构从后外侧至后内侧依次为下胫腓后韧带、下胫腓横韧带及胫距后韧带。下胫腓后韧带附着于胫骨后外侧,最高点距离关节面(45.2±5.6)mm。下胫腓横韧带附着于胫骨后方远端,最高点距离关节面(5.5±1.0)mm。胫距后韧带附着于内踝后丘或丘间沟,中心距丘间沟(2.5±0.6)mm。296例后踝骨折患者中,Ⅰ型、Ⅱ型及Ⅲ型分别为36例、229例(ⅡA 150例,ⅡB 79例)及31例(ⅢA 11例,ⅢB 20例)。ⅡB型后踝骨折占关节面百分比、后踝骨折向近端移位程度及距骨向后脱位程度明显大于ⅡA型后踝骨折[23.7(18.6,28.8)%∶18.4(12.7,21.7)%、4.1(2.1,6.0)mm∶1.9(0.2,3
Objective To propose a new classification of posterior malleolus fracture to further clarify its pathoanatomy.Methods Twenty fresh frozen cadaver specimens of normal morphology of lower limbs were selected and dissected and the extent of the tibial insertion of posterior malleolus associated ligaments was measured.At the same time,a retrospective case series analysis was made on the clinical and CT information of 296 patients with posterior malleolus fracture treated at Tongji Hospital of Tongji University from January 2012 to July 2020 or at Karamay Central Hospital from January 2018 to July 2020.The percentage of articular involvement of the fracture,proximal displacement of the posterior malleolus fracture and extent of posterior talar subluxation were measured.A clinically practical new classification system for posterior malleolus fracture was created by correlating posterior malleolus associated ligaments with CT images of posterior malleolus fracture.The new classification included three types:type I was posterior malleolus fracture with only the tibial insertion of inferior transverse tibiofibular ligament involved;type II was posterior malleolus fracture with both the tibial insertions of inferior transverse tibiofibular ligament and posterior inferior tibiofibular ligament involved,which was divided into subtypes IIA and IIB based on the presence of articular cartilage and subchondral bone damage,compression or Die-Punch fragments;type III was posterior malleolus fracture that involved all the tibial insertions of inferior transverse tibiofibular ligament,posterior inferior tibiofibular ligament and posterior tibiotalar ligament,which was sub-classified into subtypes III A and III B according to number of fracture fragments.Anatomic characteristics of the extent of the tibial insertion of posterior malleolus associated ligament,CT imaging parameters for posterior malleolus fracture and corresponding fracture typing were determined.In addition,the new classification system for posterior malleolus fractur
作者
李勇奇
夏江
李兵
于涛
周海超
和文宝
李振东
俞光荣
杨云峰
Li Yongqi;Xia Jiang;Li Bing;Yu Tao;Zhou Haichao;He Wenbao;Li Zhendong;Yu Guangrong;Yang Yunfeng(Department of Orthopedics,Tongji Hospital of Tongji University,Shanghai 200065,China;Department of Orthopedics,Karamay Central Hospital,Karamay 834000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第5期444-451,共8页
Chinese Journal of Trauma
基金
上海市科委项目(21ZR1458500)。
关键词
踝骨折
韧带
分型
Ankle fractures
Ligaments
Classification
