旋转型踝部损伤内侧延伸型后踝骨折形态学研究

Study of the morphological characteristics of medial-extension posterior malleolus fracture in rotational ankle injury

目的研究旋转型踝部损伤内侧延伸型后踝骨折形态学特点。方法回顾性分析2011年1月至2020年12月上海交通大学医学院附属第九人民医院收治78例旋转型踝部损伤内侧延伸型后踝骨折患者临床资料,根据骨折线形态分为单折线组和多折线组。记录Lauge-Hansen分型、合并损伤,绘制骨折线地图,测量CT横断面骨折线夹角(θ)、矢状面骨折线夹角(γ)、横断面骨折块面积比(FAR1)、矢状面骨折块面积比(FAR2)、骨折高度(H)和下胫腓联合距离(TFD)。结果单折线组30例,多折线组48例。两组Lauge-Hansen分型无显著性差异(P>0.05)。单折线组内侧骨折线开口多在内踝后丘,而多折线组则偏向前侧,部分累及前丘(P<0.01)。单折线组合并胫骨穹窿骨软骨损伤、内踝骨折及下胫腓联合损伤概率均低于多折线组(P<0.01);两组在合并腓骨骨折和距骨骨软骨损伤方面无显著性差异(P>0.05)。单折线组θ角、FAR1小于多折线组(P<0.05);两组γ角、FAR2及H无显著性差异(P>0.05)。单折线组H、FAR1、FAR2间相关性强于多折线组(P<0.05)。结论单折线组形态规则,骨折线偏向冠状面,内侧骨折线开口多靠近后丘;多折线组形态多变,外侧骨折线偏向矢状面,内侧骨折线开口靠近前丘,多合并内踝、胫骨穹窿骨软骨骨折及下胫腓联合损伤。

Objective To study the morphological characteristics of medial-extension posterior malleolus fracture in rotational ankle injury and guide treatment.Methods Retrospective analysis of 78 cases of medial-extension posterior malleolus fracture patients in rotational ankle injury that were treated in our hospital from January 2011 to December 2020.The patients were divided into a single-fracture-line group(SF group)and a multi-fracture-lines group(MF group)according to the number of fracture lines.The Lauge-Hansen classification and the combined injury were recorded,and a fracture line map was drawn.The following CT indicators were measured,including the angle of the fracture line in cross sectionθ,the angle of the fracture line in sagittal sectionγ,the cross-sectional fracture area ratio FAR1,the sagittal sectional fracture area ratio FAR2,the fracture height H,and the lower tibiofibular joint distance TFD.Results There were 30 cases in the SF group and 48 cases in the MF group.There was no significant difference between the SF and MF groups in the Lauge-Hansen classification(P>0.05).The opening of the medial fracture line in the SF group was almost in the posterior colliculus of the medial malleolus,whereas that in the MF group was more anterior and partially involved the anterior colliculus(P<0.01).The probabilities of osteochondral injury of the tibial plafond,medial malleolus fracture,and lower tibiofibular syndesmosis injury in the SF group were lower than in the MF group(P<0.01).There were no significant differences in fibular fracture and osteochondral injury of the talus(P>0.05).Theθangle and FAR1 in the SF group were smaller than in the MF group(P<0.05).There were no significant differences in theγangle,FAR2,and H.In addition,the correlations among H,FAR1,and FAR2 in the SF group were stronger than in the MF group(P<0.05).Conclusions Compared with the SF group,the fracture morphology in the MF group was variable.The fracture line in the SF group was more inclined to the coronal plane,whereas the lateral fracture line in the MF group was more inclined to the sagittal plane.The opening of the medial fracture line in the SF group was closer to the posterior colliculus,whereas that in the MF group was closer to the anterior colliculus.In addition,the MF group was mostly associated with medial malleolus fracture,osteochondral injury of the tibial plafond,and lower tibiofibular syndesmosis injury.