跟骨外侧壁的三维形态学特征及跟骨解剖型钢板的匹配性研究

Three-dimensional morphological characteristics of calcaneal lateral facet and calcaneai anatomicalplatd

目的探讨基于CT图像后处理技术的跟骨外侧壁三维形态学特征及跟骨解剖型钢板的匹配度。方法收集2009年12月至2012年1月期间100例（男50例，女50例）保留正常跟骨患者的16排螺旋CT扫描薄层原始数据。采用表面重建法（SSD）重建跟骨及其周围骨性结构的三维图像；应用三维拓扑窄区分割技术提取跟骨；应用三维空间点、线二元素结合的测量模式进行跟骨外侧壁相关参数的测量；并模拟和观察常用跟骨解剖型钢板的置放情况。结果本研究中男性组跟骨外侧壁的长度、高度、跟骨前部高度及跟骨后关节面长度平均分别为（80．4±3．8）、（45．4±3．0）、（24．2±2．2）、（29．3±3．1）mm；女性组平均分别为（69．5±4．2）、（36．2±3．1）、（21．1±1．1）、（23．5±2．5）mm，以上项目两组间比较差异均有统计学意义（P〈0．05）。男性组跟骨前长度平均为（21．3±1．5）mm，女性组平均为（21．1±1．1）mm，差异无统计学意义（P〉0．05）。男性组Gissane角和BOhler角平均分别为128．4。±11．7°、51．2°±6．1°。，女性组分别为124．3°±8．6°、58．3°±6．7°。，两组比较差异均有统计学意义（P〈0．05）。在钢板匹配度分析中，不同类型钢板均可较理想地贴附骨面，但仍有部分钢板需剪切或折弯。结论本研究结果为跟骨骨折的解剖复位标准及畸形愈合矫形术前计划提供了一组科学、客观的参考数据。对跟骨解剖型钢板匹配度的深入认识可协助临床医生合理选择内置物并正确置放。

Objective To explore the three-dimensional （3-D） morphological characteristics of the calcaneal lateral facet using CT image post-processing technique and the match of the caleaneal anatomic plate to the characteristics. Methods We collected the thin-slice CT data of 100 patients with normal calca- neus （50 males and 50 females） who had undergone 16-slice spiral CT scanning from December 2009 to January 2012. Surface shaded display （SSD） technique was used to reconstruct 3-D images of the calcaneus and its associated bony structures. The calcaneus was isolated by 3-D topological narrow division technique. The parameters of point, line and surface concerning the calcaneal lateral facet were measured. The fixations with conventional calcaneal anatomic plates were simulated and matches of the plates to the 3-D morphology of the calcaneus were observed. Results The mean length and height of the lateral facet, the mean height of the anterior part and the mean length of the posterior articular surface were respectively 80.4± 3.8 mm, 45.4±3.0 ram, 24.2±2.2 remand29.3±3.1 mm in male group and 69. 5±4. 2 ram, 36.2±3.1 mm, 21.1 ± 1. 1 mm and 23.5 ±2.5 mm in female group. There were significant differences between the 2 groups in all the above parameters （ P 〈 0. 05 ） . There was no significant difference in the length of anterior part between the 2 groups （male： 21.3 ＋ 1.5 mm versus female： 21.1 ＋ 1.1 ram） （P 〉 0.05）. The Gissane＇s angle and the Bohler＇s angle were respectively 128.4°± 11.7° and 51.2°± 6. 1° in male group while 124.3°± 8.6° and 58.3°± 6.7° in female group, with significant differences between the 2 groups （ P 〈 0.05）. Match observations revealed that the plates of all kinds attached the bon facet well but some plates still needed cutting or bending. Conclusions The present study provides a series of scientific and objective data for operative protocols planned before anatomic reduction of the caleaneal fractures and orthomorphia for the malunion. A better understanding of how the calcaneal anatomic plate matches the calcaneal morphology may help or- thopaedists select and locate the implant correctly.