摘要
背景:踝关节骨折中的内踝形态十分复杂,不同程度的内踝损伤影响踝关节骨折的稳定性和最终的治疗方法。目的:利用三维CT研究踝关节骨折中内踝形态的特点,探讨内踝形态的分型方法和对治疗策略的影响。方法:选取2015年1月至2018年1月在我院行踝关节三维CT检查并接受手术治疗的143例踝关节骨折患者,年龄19~85岁,平均(53.1±15.9)岁。收集全部患者的一般资料,阅读术前三维CT片后根据内踝形态的特点进行分型。对于部分内踝骨折的病例,能够在CT片上测量骨折线的冠状面角度(α)和矢状面角度(β)。结果:本研究中的内踝形态大致可分为4型:1型,内踝无骨折或有撕脱骨折;2型,前丘骨折累及不同范围后丘;3型,后丘骨折伴或不伴前丘骨折;4型,内踝粉碎骨折。其中2型可进一步分为两个亚型:2a型(丘下骨折)和2b型(丘上骨折)。对2型中内踝骨折线的测量结果显示,α为28.8°±17.4°,β为26.4°±8.0°。两个亚型之间的α和β值差异有统计学意义(P<0.001)。结论:三维CT有助于认识不同的内踝形态并指导分型。2型内踝形态中两个亚型内踝骨折线角度差异有统计学意义。这些发现凸显了踝关节骨折中内踝形态的多样性,有助于临床医师根据不同的内踝形态制定治疗方案。
Background:The medial malleolar pattern is complex in ankle fracture and different types of medial malleolar injury affect the stability of ankle to different degrees in the fractures and play critical role in formulating rational treatment strategy.Objectives:To investigate the features of medial malleolar patterns based on three dimensional computed tomography and to explore a classification method and the impact of medial malleolar pattern on ankle fracture treatment.Methods:From January 2015 to January 2018,143 patients(143 ankles)with ankle fracture who had undergone ankle CT scan at our hospital were recruited with a mean age of 53.1±15.9 years(range,19 to 85).The general information of the patients was collected.The medial malleolar patterns of the patients were recognized by their features based on the three dimensional computed tomography taken before the operation.Two parameters including coronal angle(α)and sagittal angle(β)were measured based on the three dimensional computed tomography.Results:The medial malleolar patterns of the patients were classified into 4 types as no fracture or flake fracture named type 1;anterior collicular fracture involving different proportion of the posterior colliculus named type 2;posterior collicular fracture with/without anterior collicular fracture named type 3;medial malleolar comminuted fracture named type 4 and of which the patients of type 2 were further divided into two sub-types as 2 a(upper collicular fracture)and 2 b(lower collicular fracture).The fracture lines of malleolus medialis were determined byαangle of 28.8°±17.4°(range,-10.1°to 80.5°)andβangle of 26.4°±8.0°(range,5.3°to 48.6°)in the patients of type 2 and the differences ofαangle andβangle between the two subgroups were statistically significant(P<0.001).Conclusions:Three dimensional computed tomography is helpful to recognize the medial malleolar patterns and classification.There are statistically significant differences in the angles of medial malleolus fracture lines between the
作者
彭建光
王强
李旗
刘利民
PENG Jianguang;WANG Qiang;LI Qi;LIU Limin(Department of Orthopedics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华骨与关节外科杂志》
2019年第8期609-614,共6页
Chinese Journal of Bone and Joint Surgery
关键词
踝关节骨折
内踝
形态学
三维CT
手术治疗
Ankle Fracture
Malleolus Medialis
Morphology
Three Dimensional Computed Tomography
Surgical Treatment
