Mimics软件重建踝部模型分析距骨周围脱位的损伤特征

Analysis of injury characteristics of peritalar dislocations using ankle models reconstructed with software Mimics

目的利用Mimics软件重建踝部模型分析距骨周围脱位的损伤特征。方法回顾性分析武汉市第四医院骨科2008年1月至2022年4月期间诊治的36例距骨周围脱位患者资料。男28例,女8例;年龄(46.0±14.6)岁;左侧16例,右侧20例。调取CT数据导入Mimics软件重建踝部模型,观察距骨后内侧突骨折的发生情况、距骨之外周围骨性结构的附属损伤情况,距舟关节完全或不完全脱位情况。结果36例患者中,32例(88.9%,32/36)患者发生距骨后内侧突骨折;24例(66.7%,24/36)患者发生除距骨之外周围骨性结构的附属损伤,共计33处,其中外踝撕脱性骨折12处,内踝撕脱性骨折4处,舟骨损伤7处,跟骨损伤6处,骰骨3处,第5跖骨骨折1处。16例患者合并1处附属损伤,7例患者合并2处附属损伤,1例患者合并3处附属损伤。两处或以上附属损伤的患者共8例均为距舟关节完全脱位。36例患者中距舟关节完全脱位26例,距舟关节不完全脱位10例;距舟关节完全脱位患者中合并有附属损伤的发生率84.6%(22/26)显著高于距舟关节不完全脱位患者的20.0%(2/10),差异有统计学意义(P=0.001)。结论距骨周围脱位多数合并有距骨后内侧突骨折,距舟关节完全脱位者占比高,且附属损伤的发生率高,甚至是2处及以上的多处损伤。

Objective To analyze the injury characteristics of peritalar dislocations using ankle models reconstructed with software Mimics.Methods A retrospective study was conducted to analyze the medical records of 36 patients with peritalar dislocation who had been treated at Department of Orthopaedics,The Fourth Hospital of Wuhan from January 2008 to April 2022.There were 28 males and 8 females with an age of(46.0±14.6)years,and 16 left and 20 right limbs.Their CT data were imported into software Mimics to reconstruct ankle models to observe the fractures of the postero-medial process of the talus,the affiliated injuries to the surrounding bone structures outside the talus,and the complete or incomplete dislocations of the talonavicular articulation.Results 32 patients(88.9%,32/36)had fracture of the postero-medial process of the talus,and 24 patients(66.7%,24/36)a total of 33 affiliated injuries to the surrounding bone structures outside the talus,including 12 lateral malleolus ones,4 medial malleolus ones,7 scaphoid ones,6 calcaneus ones,3 fractures of the cuboid and 1 fracture of the fifth metatarsal.Sixteen patients were complicated with 1 affiliated injury,7 patients with 2 affiliated injuries,and 1 patient with 3 affiliated injuries.The 8 patients with 2 or more affiliated injuries all had complete dislocation of the talonavicular articulation.Of the 36 patients,26 had complete dislocation of the talonavicular articulation and 10 incomplete dislocation of the talonavicular articulation.The incidence of affiliated injuries[84.6%(22/26)]in the patients with complete dislocation of the talonavicular articulation was significantly higher than that[20.0%(2/10)]in those with incomplete dislocation of the talonavicular articulation(P=0.001).Conclusions Most of the peritalar dislocations are combined with the fracture of the postero-medial process of the talus.The incidence of complete dislocation of the talonavicular articulation is high.Patients with complete dislocation of the talonavicular articulation are more likely to have an affiliated injury,or even more than two injuries.