后丘延伸型后踝骨折的CT三维重建分型与治疗

Classification and Treatment of the Posterior Malleolus Fractures Involving the Posterior Colliculus of the Medial Malleolus by 3D CT Images

目的研究内踝后丘延伸型后踝骨折的CT三维重建分型方法及该分型指导下的术式选择。方法回顾性分析2009年6月至2014年6月收治的44例内踝后丘延伸型后踝骨折患者,其中男16例,女28例;年龄44～72岁,平均50.2岁。车祸伤12例,跌倒扭伤32例。左踝25例,右踝19例,均为闭合性骨折。运用CT三维重建进行分型,根据后踝骨块上缘与下胫腓联合骨性上界水平的关系及后踝骨块与内踝后丘骨块是否分离,将内踝后丘延伸型后踝骨折分为A、B两型,每型分两亚型,根据分型选用外侧或后外侧联合后内侧入路进行手术内固定。结果 44例手术患者Baird-Jackson评分,优4例,良16例,可20例,差4例。结论运用CT三维重建可以较好地对内踝后丘延伸型后踝骨折进行分型,并能有效指导术式选择,取得较好的临床效果。

Objective To study how to classify the posterior malleolus fractures which extend to the posterior colliculus of the medial malleolus by three-dimensional computed tomography reconstruction（3-D CT） and choose the corresponding surgical approaches according to the classification. Methods From June 2009 to June 2014,44 patients with posterior malleolus fractures which extended to the posterior colliculus of the medial malleolus were treated in our hostial. On the basis of the 3D CT images. These fractures were categorized into type A and type B,with the subtypes of number1 and number 2. The classification depends on the relationship of the upper margin of between the posterior malleolar fragments and the tibiofibular syndesmosis osseous upper margin firstly,whether there were fracture lines between the posterior malleolus fragments and the osterior colliculus of the medial malleolus or not secondly. The surgical approaches included posteriormedial incisions combing with lateral or posteriolateral incisions. Results According to the Baird-Jackson Ankle Scoring System,the results were rated as excellent in four case,good in sixteen cases,moderate in twenty cases and poor in four case,with the good-excellent rate being 45. 5%.Conclusion 3D CT can help to classify the posterior malleolus fractures involving the posterior colliculus of the medial malleolus,select the best surgical approaches and achieve satisfactory clinical results.