基于计算机辅助骨科技术的腓骨远端形态学特征研究及其临床意义

Morphological characteristics of distal fibula and their clinical relevance： a research based on computer-assisted orthopaedic techniques

目的通过对腓骨远端三维形态学特征进行观察分析，并测量相关参数，为腓骨远端骨折的解剖复位及内固定的正确置入提供参考。方法收集2009年5月至2014年6月期间的126例含有正常踝关节结构的16排螺旋cT扫描的薄层原始数据。采用表面重建法重建出踝关节周围骨性结构的三维图像，通过三维分割技术提取腓骨远段图像；应用三维空间点、线、面三元素的组合式测量技术进行腓骨远端相关参数的测量，并根据性别分组进行比较。结果腓骨远端的形态学特征较为复杂，男性组相关形态学指标测量与女性组比较差异有统计学意义（P〈0．05），除外胫骨前结节最外侧点平面至腓骨最远端点距离、腓骨小窝近端边界点平面的腓骨外侧缘中点至对侧皮质距离及腓骨后侧嵴成角比较差异无统计学意义（P〉0．05）。观察者内及观察者间一致性组内相关系数检验结果较高。结论行腓骨远端内固定手术时，若采用外侧钢板，钢板放置不宜过远；若采用后外侧钢板，置入螺钉在胫骨前结节起始平面近端可采用双皮质固定；若采用后侧钢板，需对直重建钢板远端进行塑型。

Objective To provide references for anatomical reduction and correct implantation in treatment of distal fibular fracture by analyzing morphological characteristics of distal fibula on three-dimensional （3D） modes. Methods 16-row spiral CT scans of 126 normal ankle structures from May 2009 to June 2014 were collected. Surface shaded display technique was used to reconstruct 3-D images of bones around the ankle. The distal fibula was extracted using 3D segmentation technique. The parameters of distal fibula were measured by selecting points, lines and surfaces on the 3D models. Results The morphological characteristics of distal fibula were complicated. Significant differences were observed between males and females in most parameters （ P 〈 0. 05）, but not in the length between the plane of the most lateral point of the tibial anterior node and the most distal point of the fibula, the length between the midpoint of lateral border of the fibula and its opposite cortex on the plane of the most proximal border of the fibular fossa or the mean angle of posterior crest of the fibula （ P 〉 0.05）. The intra and interclass correlation coefficients （ICC） were excellent. Conclusions When a lateral plate is used for internal fixation of distal fibula, the plate should be placed as proximally as possible. When a posterior-lateral plate is used, the screws to be inserted on the plane proximal to the initial point of anterior node of the tibia can be fixed bi-cortically. When a posterior plate is used, pre-contour of the plate before insertion is required.