旋后外旋型踝关节骨折的后踝骨折线分布研究

Distribution of posterior malleolus fracture fines in ankle fracture of supination-external rotation

目的研究Lauge—Hansen旋后外旋型踝关节骨折的后踝关节面骨折线分布特点。方法70例旋后外旋型骨折患者的CT扫描数据纳入本研究。使用Mimics16．0软件对所有患者的DICOM数据进行分析，去除距骨、复位骨折后，标识出后踝关节面上的骨折线。使用Photoshop 10．0将70例骨折线绘制于同一张标准化的胫骨远端关节面上，最终根据骨折线出现频次绘制热图。结果尽管后踝关节面骨折线变化各异，大多数骨折线仍位于一弧形条带区域内。后踝骨折块关节面占胫骨远端关节面面积的比例平均为14．96％（2．23％～38．45％）。出现频率最高的后踝关节面骨折线起始于距离后缘切线20．4％的位置，结束于距离外缘切线58．7％的位置。结论旋后外旋型踝关节骨折后踝关节面骨折线有一定规律，其位于一个弧形条带区域内。

Objective To study the distribution of intra-articular posterior malleolus fracture lines in ankle fracture of supination-external rotation. Methods Computed tomography scans of a consecutive series of 70 ankle fractures of supination-exterual rotation were used for this study. The DICOM files were loaded into Mimics 16.0 for 3D reconstruction of distal tibial articular surface. The intra-articular posterior maUeolus fracture fines were identified after virtual fracture reduction. All the fracture lines were drawn on one picture of distal tibial articular surface after standardization before a heat map was created based on the fre- quency of fracture lines. Results Although the distribution of posterior malleolus intra-articular fracture lines varied, most of them were concentrated in an arcuate zone. The ratios of the area of posterior fracture fragment to the total area of articular surface averaged 14. 96% （range, from 2.23% to 38.45% ）. They were most likely to enter the articular surface at 20. 4% of the tangent of the posterior edge in a standardized image and exit at 58.7% of the tangent of the lateral edge. Conclusion In ankle fractures of supina- tion-exterual rotation, most intra-articular posterior maUeolus fracture lines may be distributed regularly in an arcuate zone of the articular surface.