发生后踝骨折的两种不同类型骨折的比较

Comparison of two kinds of fractures involving posterior maHeolar fracture

目的探讨胫骨螺旋形骨折合并后踝骨折与后踝发生骨折的单纯踝关节骨折的区别。方法回顾性调查1685例成人胫腓骨骨干骨折、1871例单纯踝关节骨折，对这两种骨折中存在后踝骨折的患者的致伤原因、损伤机制等进行分析。结果1685例胫骨干骨折患者中，胫骨干骨折合并踝关节骨折患者82例，其中28例为胫骨螺旋形骨折合并后踝骨折，28例患者平均年龄（41．1±11．8）岁。单纯踝关节骨折患者1871例，发生后踝骨折患者330例，330例患者平均年龄（42．6±15．9）岁。胫骨干骨折合并踝关节骨折中后踝骨折的发生率大于单纯踝关节骨折中后踝骨折的发生率。胫骨螺旋形骨折合并后踝骨折与有后踝骨折的单纯踝关节骨折的外踝与后踝同时骨折发生率、腓骨骨折线位置比较差异有统计学意义。结论胫骨螺旋形骨折合并后踝骨折是一种有规律的特殊类型骨折，这种骨折与单纯踝关节骨折中存在的后踝骨折在受伤机制、治疗原则方面有本质区别。

Objective To investigate the difference between the spiral tibial shaft fracture combined with ipsilateral posterior malleolar fracture. （TSPMF） and simple ipsilateral posterior malleolar fracture in ankle joint fracture in adults. Methods The sex, age, and type and mechanism of fracture of 82 patients with tibial shaft fracture associated with ankle joint fracture （TAF） and 28 patients with tibial shaft spiral fracture associated with ipsilateral posterior malleolar fracture （TSPMF） among 1685 cases of adult tibial and fibular shaft fracture and 330 patients with posterior malleolar fracture among 1871 cases of simple ankle joint fracture were analyzed. Results The mean age of the 28 cases with TSPMF, 24 males and 4 females, was （41.1 ± 11.8 ）. The mean age of the 330 eases with simple posterior malleolar fracture, 187 males and 143 females, was （42.6 ± 15.9）. The incidence of posterior malleolar fracture in the TAF patients was 34. 1% （28/82）, significantly higher than that of the simple ankle joint fracture [ 17.6%, 330/1871, P = 0. 000 ]. The rate of combined external malleolus and posterior malleolus in the TSPMF patients was 17.9% （5/28） , significantly that in the patients with simple ankle joint fracture （73.7 % , 159/330, P = 0. 000 ）. The fibular fracture line of 75.0% （21/28） of the TSPMF patients was located over the level of the lower tibiofibular ligament union, a rate significantly higher than that in the simple melleolus fracture （24. 8% , 82/330,P = 0. 000）. Conclusion Spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture is a special kind of fracture; the cause and mechanism of TSPMF are difference from those of the ankle joint fracture.