下胫腓联合损伤螺钉内固定治疗的影像学研究

The radiographic study of screw internal fixation for syndesmosis injuries

目的通过踝关节3个不同平面CT断层影像获得下胫腓定位螺钉的最佳置入途径,为手术中正确置入螺钉提供简便的操作方法。方法对100例单侧下肢损伤患者健侧踝关节CT轴位图像进行测量分析,取踝关节中立位状态下关节面近端2、3、5 cm水平的轴位CT影像,测量胫骨及腓骨的中心点,研究胫、腓骨中心点连线与腓骨外侧脊的关系及与水平面的成角。结果 100例CT图像数据中,位于踝关节近端2 cm平面置入点位于腓骨外侧脊顶端上,与水平成角10.95°±4.52°;近端3 cm平面置入点位于腓骨外侧脊顶端后方1.15 mm±0.35 mm,与水平成角13.74°±4.42°;近端5 cm平面置入点位于腓骨外侧脊顶端后方2.65 mm±1.05 mm,与水平成角17.07°±4.96°。其中男、女性之间未见明显差异(P>0.05)。结论腓骨外侧脊作为特定及恒定的解剖结构对术中操作具有重要的参考作用,可为手术提供简便有效的操作方法,能正确置入下胫腓定位螺钉,降低失误率。

Objective To study the best path for inserting syndesmosis positioning screw in 3 different axial plane proximal to the coronal plane ot＂ the ankle, to provide a more intuitive and less complicating reference for syndesmosis fixation. Methods CT scans in the opposite side of 100 single lower limb injury patients were examined and meas- ured by image measurement software in axial plane of 2 cm, 3 cm and 5 cm proximal to the talar dome in neutral posi- tion of the ankle, and to find out the best syndesmosis screw inserting route passing through the two eentroids of the tibia and fibula, and to study the relatiou between the route and the lateral cortical apex of the fibula, along with the angle between the route and the horizontal. Results In the 100 cases of imaging data, the best symtesmosis screw inserting route located on the lateral cortical apex of the fibula in the axial plane of 2 cm and 10. 95 °±4. 52° posterior to the horizontal; the route located 1.15 mm ±0. 35 mm posterior to lateral apex oi： the fibula in the axial plane of 3 em and 13.74° ±4.42° to the horizontal; the route located 2.65 mm ± 1.05 mm posterior to the lateral apex of the fibula in the axial plane of 5 cm and 17.07° ± 4. 96° to the horizontal, with no gender correlation（ P 〉 0. 05 ）. Con- clusions The lateral apex of the fibula plays a very important role in locating the syndesmosis screw inserting point, and this study can provide more convenience along with higher accuracy for syndesmosis screw fixation.