旋后外旋型踝关节骨折中后踝骨折块的三维分布热图研究

Heatmap characteristics and treatment options of posterior malleolus fractures in supination-external rotation ankle fracture

目的探讨Lauge-Hansen旋后外旋型踝关节骨折的后踝骨折块的立体骨折线-面-三维立体分布情况,为临床提供参考。方法回顾性分析2012年1月—2017年3月同济大学附属同济医院收治的70例旋后外旋型Ⅲ/Ⅳ度后踝骨折患者的CT扫描数据及临床资料,将所有医学数字成像和通信数据使用Mimics 16.0进行分析,复位骨折后,使用3-Matic软件在立体图形中标识骨折线。进行标准化后,将所有后踝骨折块的立体骨折线绘制于同一三维立体图像中。最终绘制出骨折线和骨折面的热图。结果后踝关节面骨折线变化各异,但大部分骨折线仍集中于一条弧形带状区域。该带状区域始于距离后缘切线1/7~2/7的位置,止于距离外缘切线5/11~7/11的位置。后踝骨折块关节面占胫骨远端总关节面面积的比例平均为14.96%(2.23%~38.45%)。立体骨折块出现频率最高的区域位于标准底部视角后侧的2/11、标准内侧视角后侧的1/9、标准外侧视角后侧的1/11。结论后踝骨折的位置变异较大,大部分骨折块位于后外侧,即主要为HaraguchiⅠ型或Bartonicek-Rammelt 2型骨折。对于后踝骨折的线-面-三维研究,有助于手术计划的制定、损伤机制的探索,以及为生物力学或有限元建模提供理论依据。

Objective To study the one, two and three-dimensional distribution of posterior malleolus fracture lines in ankle fracture of supination-external rotation. Methods Computed tomography scans of a consecutive series and clinical data of 70 ankle fractures of supination-external rotation type Ⅲ/Ⅳ treated in Tongji Hospital Affiliated to Tongji University from January 2012 to March 2017 were retrospectively analyzed. The initial digital imaging files were analyzed by Mimics 16.0 and 3D reconstruction. The three-dimensional fracture lines were identified using 3-Matic software after virtual fracture reduction. The three-dimensional fracture lines of all posterior malleolar fracture blocks were drawn in the same three-dimensional image after standardization. Then, a heatmap of fracture line and surface was drawn. Results Although the distribution of posterior malleolus intra-articular fracture lines varied, most of them were concentrated in a curved region. This region started at 1/7-2/7 tangent of the posterior edge in the posterior malleolusa standardized image and ended at 5/11-7/11 . The proportion of the articular surface of posterior malleolus fracture fragment to the total area of articular surface was averaged 14.96%(range, from 2.23% to 38.45%). The region with the highest frequency of the three-dimensional fracture block was located in the posterior 2/11 at bottom view, in the posterior 1/9 at standard medial view and in the posterior 1/11 at lateral view. Conclusions The position of the posterior malleolus fracture is highly variable, and most of the fracture block is located in the posterolateral side, which are mainly Haraguchi type I or Bartonicek-Rammelt type 2 fractures. The line-surface-3D study of posterior malleolus fractures facilitates the development of surgical plans, the exploration of injury mechanisms, and provides a theoretical basis for biomechanical or finite element modeling.