半蹲式跳伞胫腓骨及踝关节骨折损伤分型及骨折区段分析

Fracture Classification and Injury Segment Analysis of Tibiofibula and Ankle in Half-Squat Parachuting Landing

目的对跳伞着陆中胫腓骨和踝关节骨折病例进行分型及损伤区段测量分析,探究伞伤骨折的主要类型和易发区段。方法收集并筛选得到56例跳伞着陆骨折损伤病例,基于数字化X线片图像对胫腓骨和踝关节骨折分别使用AO-OTA标准和Lauge-Hansen标准进行分型,将与踝关节胫骨和距骨关节面的距离相等的平面定义为零平面,标定胫腓骨损伤最高和最低点以确定骨折区段并进行统计分析。结果在胫腓骨和踝关节伞伤骨折中,胫腓骨一并骨折占80.4%。胫腓骨骨折以42-D/5.2(45.8%)、42-D/5.1(16.7%)为主要分型;踝关节骨折以旋前外旋型(59.4%),旋后外旋型(37.5%)为主要分型。在胫腓骨及踝关节伞伤骨折时,胫骨骨干在零平面向上57~143 mm、零平面以下6 mm至以上24 mm区段、腓骨在零平面以上4~45 mm、74~83 mm区段内均有超过50%概率存在骨折损伤。结论在跳伞下肢损伤防护中,胫腓骨骨干均骨折的情况应被重点防护,旋前外旋和旋后外旋这两类踝关节骨折的扭转机制应该予以重点防护。

Objective To make classification and segment measurement for the cases with tibiofibular and ankle fractures in parachuting landing,and investigate main classification types of parachuting fractures and fracture segments of high risk.Methods A total of 56 fracture cases in parachuting landing were collected,and the tibiofibula and ankle fractures were classified according to AO-OTA or Lauge-Hansen classification standards respectively based on their digital X-ray images.The medium plane between talus and tibia joint planes in ankle joint was defined as the reference plane.The highest and lowest injury points of tibia and fibula were marked respectively,and the fracture segment was defined between the highest and lowest point for statistical analysis.Results For tibiofibular and ankle fracture cases in parachuting landing,fracture at both tibia and fibula accounted for 80.4%.The major classification of tibiofibula fracture was 42-D/5.2(45.8%)and 42-D/5.1(16.7%).The major classification for ankle fracture was pronation-external rotation(PER,59.4%)and supination-external rotation(SER,37.5%).When tibiofibular and ankle fracture cases in parachuting landing occurred,the fracture segment of the tibia was mainly from 57 to 143 mm above the reference plane and from 6 mm below the reference plane to 24 mm above the reference plane,while the fracture segment of the fibula was 4-45 mm and 74-83 mm above the reference plane.Injury risks of all above segments were higher than 50%.Conclusions For protection of lower limbs in parachuting landing,the fracture at both tibia and fibula should be highly noticed.The ankle motion of PER and SER should be especially restricted in parachuting ankle protection.