75例青少年胫骨远端三平面骨折的三维CT特征研究

Title Study on the fracture line of 75 adolescents with triplanar fracture of tibia

目的总结75例青少年胫骨远端三平面骨折的三维CT特征,分析其骨骺骨折线特点以及胫骨远端骨骺各区块骨折的发生规律。方法回顾性分析厦门大学附属福州第二医院小儿骨科2015年1月到2021年4月收治的75例青少年胫骨远端三平面骨折患者资料,男47例(62.7%),女28例(37.3%);年龄10~15岁,平均12.5岁;75例均接受正、侧位X线片及三维CT检查。按照胫骨骨块数量、骨折线走向、骨折线累及区域(内踝关节外、内踝关节内非负重区,内踝关节内负重区,其他胫骨负重区)、是否合并腓骨骨折、是否合并距骨骨折以及胫骨干骨折进行分类,分析骨折特点。结果75例三平面骨折中,干骺端骨折线均为内外走向,骨骺端骨折线变异较大。二部分骨折56例(74.7%),其骨骺端骨折线分3种类型:42例(56%)为Ⅲ型内踝三平面骨折;13例(17.3%)骨骺骨块从前向后走向,在Kump's bump区域外侧跨过该区域,转向后内侧;1例(13.3%)为Ⅰ型内踝三平面骨折。三部分骨折16例(18.6%),骨骺端骨折线分3种类型:9例(12%)骨骺端骨折形态均表现为“奔驰标”样;3例(4%)骨骺端骨折形态与Tillaux骨折相同;4例(5.3%)内踝有2处骨折线;2例(2.7%)为内踝Ⅰ型+Ⅲ型;2例(2.7%)为内踝Ⅱ型+Ⅲ型骨折(图2D)。四部分骨折3例(4%)。25例(33.3%)伴腓骨骨折,1例(13.3%)伴胫骨干骨折,胫骨干骨折线为斜行后上斜向前下。3例(4%)伴有距骨关节面软骨剥脱。结论本研究分析75例胫骨远端三平面骨折患者三维CT结果,以及其骨骺端骨折线分布特点,有助于胫骨三平面骨折的临床诊断及判断术中置钉角度。按照骨折块数量三平面可分为两部分(3种亚型)骨折、三部分(3种亚型)骨折、四部分骨折。其中两部分骨折最常见,骨骺骨折最常累及内踝关节外,需警惕伴有距骨软骨面剥脱和伴有胫骨干骨折的三平面骨折。

Objective To analyze the characteristics of the epiphyseal fracture line of 75 adolescents with triplanar fractures of the distal tibia and reclassify them.Methods From January 2015 to April 2021,75 cases of triplanar fractures of the distal tibia were treated in the Department of Pediatric Orthopedics of our hospital.All patients received positive and lateral X-rays and three-dimensional CT examinations.The age,gender,and epiphysis of the patients were recorded.Characteristics of fracture line.The shin medial malleolus fractures were reclassified on the basis of triplane fracture classification.Results Among 75 triplane fractures,47 were males(62.7%)and 28 were females(37.3%);the age was 10-15 years,with an average of 12.5 years.The fracture lines of the metaphysis are both internal and external,and the fracture lines of the epiphysis have greater variation.There were 56 cases(74.7%)of 2 fractures,and there were 3 types of epiphyseal fracture lines:42 cases(56%)were typeⅢtriplanar fractures of the medial malleolus;13 cases(17.3%)had epiphyseal bone fragments running from front to back,in Kump's The bump area crossed the area outside and turned to the posterior medial side;one case(13.3%)had a typeⅠtriplanar fracture of the medial malleolus.There were 16 cases(18.6%)of 3 fractures,and there were 3 types of epiphyseal fracture lines:9 cases(12%)of epiphyseal fractures showed“Benz mark”;3 cases(4%)of epiphyseal fractures and Tillaux fractures The same;4 cases(5.3%)had 2 fracture lines in the medial malleolus,2 cases(2.7%)had medial malleolus typeⅠ+typeⅢ;2 cases(2.7%)had medial malleolus typeⅡ+typeⅢfractures(Figure 2D).3 cases(4%)of 4 fractures.Twenty-five cases(33.3%)had fibula fractures,and 1 case(13.3%)had tibial shaft fractures.The fracture line of the tibial shaft was obliquely upward and forward and downward.Three cases(4%)had cartilage exfoliation on the articular surface of the talus.Conclusion In this study,75 cases of triplanar fractures were analyzed by three-dimensional CT to study the fracture lines of the epiphyses.It is the study with the largest number of triplane fractures so far.According to the number of fractures,it can be divided into 2(3 subtypes),3(3 subtypes),and 4 fractures.Two of them are the most common.Epiphyseal fractures most often involve the medial malleolus.Be wary of triplane fractures with exfoliation of the talus cartilage and tibial shaft fractures.he purpose of the study.