后踝骨折CT分型及其对临床的指导意义  

An classification of posterior malleolar fractures by computed tomography and its guide to clinical treatment

作　　者：王志生[1] 王志强[1] 李立东[1] 庞海涛[1] 周瑞红[1] 焦翔[1] 

机构地区：[1]河北省唐山市第二医院创伤科,063000

出　　处：《中国矫形外科杂志》2008年第10期736-738,共3页Orthopedic Journal of China

摘　　要：[目的]对后踝骨折进行CT分型,用于指导临床治疗。[方法]2003年1月～2006年10月治疗后踝骨折88例,男53例,女35例;年龄18～75岁,平均42.3岁。所有患者进行X线及CT检查,根据后踝主要骨折块大小、部位和骨折线等进行CT分型,并给予相应治疗。[结果]根据CT图像,后踝骨折分为四型:Ⅰ型(稳定型)23例,其中Ⅰ1型(撕脱骨块型)5例(5.7%),Ⅰ2型(小楔形骨块型)18例(20.4%);Ⅱ型(临界型)26例,其中Ⅱ1型(中等楔形骨块无距骨后外脱位型)15例(17.1%),Ⅱ2型(中等楔形骨块合并距骨后外脱位型)11例(12.5%);Ⅲ型(大楔形骨块不稳定型)18例(20.5%),Ⅳ型(中间贯穿型)21例(23.8%)。所有患者均获得随访,平均随访时间2.6年(1～4年)。根据Baird-Jackson评分系统评估疗效:优62例,良13例,可8例,差5例,优良率85.2%。[结论]CT能够明确后踝骨折的组织解剖学变化,对临床治疗有重要指导意义。[ Objective]To classify fractures of posterior malleolus by computed tomography and guide its clinical treatment. [ Method] From January 2003 to October 2006, eighty -eight patients who had been treated surgically for the posterior malleolar fractures were reviewed. There were 53 males and 35 females. The mean age was 42.3 years（ ranged, 18～75 years）. All the patients＇ preoperative radiograph and computed tomographic scans were reviewed, and each fracture was categorized according to the size,location and fracture line of the major fragment and the stable state of mortise. The classification was applied to treat 88 patients. [ Result] On the basis of the computed tomographic images, the posterior malleolar fractures were categorized into four types. There were type I （stable） in 23 cases,type II （borderline） in 26 cases,type Ill （big unstable posterolateral oblique） in 18 cases and type IV （medial-extension） in 21 cases. Type I included type I 1 （ small shell） in 5 cases and type I2 （ small posterolateral oblique） in 18 cases. Type II included type II 1 （ moderate posterolateral oblique without lateral-posterior dislocation of talus ） in 15 cases and type II 2 （ moedrate postero-lateral oblique with lateral-posterior dislocation of talus ） in 11 cases. All patients were followed up for an average of 31months （ ranged from 12 to 48 months）. According to the Baird-Jackson scoring system,the results were rated as being excellent in 62 cases,good in 13 cases,moderate in 8 cases,and poor in 5 cases,with the good-excellent rate being 85.2%. [ Conclusion] Computed tomographic scans can demonstrate the pathoanatomy of the posterior malleolar fracture and provided guidance for clinical treatment.

关 键 词：后踝骨折 分型 X线计算机 体层摄影术 

分 类 号：R683[医药卫生—骨科学] R816.8[医药卫生—外科学]