不同受伤机制下后踝骨折块的形态学分析

Morphological analysis of posterior malleolus fracture fragments under different injury mechanisms

目的探讨合并后踝骨折的踝关节骨折与合并后踝骨折的胫骨中下1/3螺旋形骨折的后踝骨折块的形态学特点和差异,分析后踝骨折块与以上2种骨折损伤类型的相关性。方法回顾性分析2011年1月—2011年12月北京积水潭医院收治的100例踝关节骨折患者的临床病例资料,其中男性59例,女性41例;年龄(42.0±14.1)岁,年龄范围17~73岁;合并后踝骨折的踝关节骨折患者有57例,为A组。同时,回顾性分析2013年1月-2013年12月北京积水潭医院收治的90例胫骨中下1/3螺旋形骨折患者的临床病例资料,其中男性42例,女性48例;年龄(45.2±13.0)岁,年龄范围18~77岁;合并后踝骨折的胫骨中下1/3螺旋形骨折患者有35例,为B组。2组共92例患者,每位患者术前行踝关节CT检查,根据Haraguchi分型明确患者骨折分型。测量横断面CT上HaraguchiⅠ型后踝骨折线与内外踝轴线的角度Ⅰa,Ⅱ型后踝骨折线与内外踝轴线Ⅱa、Ⅱb,矢状面CT上后踝骨折线与胫骨轴线夹角Ⅰc及Ⅱc。计量资料以均数±标准差((Mean±SD)表示,应用两独立样本秩和检验和χ2检验比较各角度在Ⅰ型和Ⅱ型中的差异,以及各角度在2组间差异有无统计学意义。结果92例患者中,Ⅰ型75例,Ⅱ型12例,Ⅲ型5例。Ⅰa角度为(26.6±5.6)°,Ⅰc角度为(15.4±4.1)°,Ⅱa角度为(22.1±3.3)°,Ⅱc角度为(16.4±5.4)°。Ⅰa与Ⅱa数据比较差异有统计学意义(P=0.003),Ⅰc与Ⅱc比较差异无统计学意义(P=0.667)。A组与B组中,Ⅰa角度为(26.6±5.9)°与(26.6±5.1)°,Ⅰc角度为(15.7±4.2)°与(14.9±3.9)°,Ⅱa角度为(22.0±3.0)°与(22.3±4.3)°,Ⅱb角度为(45.4±9.0)°与(46.5±10.0)°,Ⅱc角度为(17.0±5.4)°与(15.3±6.2)°。2组间相比,Ⅰa、Ⅰc、Ⅱa、Ⅱb和Ⅱc各角度差异均无统计学意义(相应P值分别为0.862、0.387、1.000、0.932和0.444)。结论后踝骨折块与合并后踝骨折的踝关节骨折、合并后踝骨折的胫骨中下1/3螺旋形骨折这2种骨折损伤类型无关。

Objective To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture,and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury.Methods A retrospective analysis was performed.One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011,including 59 males and 41 females,aged(42.0±14.1)years,with an age range of 17-73 years.Among them,57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A.Meanwhile,90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013,including 42 males and 48 females,aged(45.2±13.0)years,with an age range of 18-77 years.Among them,35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B.A total of 92 patients in the two groups were examined by CT before operation.The patient′s fracture classification was determined according to Haraguchi classification.On axial plane,the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined asⅠa in HaraguchiⅠ,angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined asⅡa andⅡb in HaraguchiⅡ,and angleⅠc andⅡc were angles between posterior malleolus fracture line and tibial axis on sagittal CT.Measurement data were expressed as mean±standard deviation(Mean±SD).Mann-whitney and Chi-square test were used to compare the differences of different angles in type I and typeⅡ,and whether there were statistical differences in different angles between the two groups.Results In the 92 cases,75 were typeⅠ,12 were typeⅡand 5 were typeⅢ.The angle ofⅠa was(26.6±5.6)°,the angle ofⅠc was(15.4±4.1)°,the angle of typeⅡa was(22.1±3.3)°,and the angle ofⅡc was(16.4±5.4)°.The difference betweenⅠa andⅡa data was statistically significant(P=0.003),but there was no significant difference betweenⅠc andⅡc(P=0.667).In group A and group B,the angle ofⅠa was(26.6±5.9)°and(26.6±5.1)°,the angle ofⅠc was(15.7±4.2)°and(14.9±3.9)°,the angle ofⅡa was(22.0±3.0)°and(22.2±4.3)°,the angle ofⅡb was(45.4±9.0)°and(46.5±10.0)°,the angle ofⅡc was(17.0±5.4)°and(15.3±6.2)°,respectively.There were no significant differences in the angles ofⅠa,Ⅰc,Ⅱa,Ⅱb andⅡc between the two groups(P values were 0.862,0.387,1.000,0.932 and 0.444,respectively).Conclusion The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.