后踝骨折以关节负重区影响的实验研究  

Effect of the Posterior Malleolar Fracture on the Loading Area of the Ankle

作　　者：汤荣光[1,2] 盛为 戴克戎[1,2] 龙公[1,2] 顾冬云[1,2] 

机构地区：[1]上海中医药大学附属曙光医院骨伤科 [2]上海第二医科大学附属第九人民医院骨科

出　　处：《中华创伤杂志》1999年第3期203-205,共3页Chinese Journal of Trauma

摘　　要：目的了解后踝骨折影响关节负重区面积及负重接触区图形的影响，以便决定后踝骨折时的手术指征。方法加载７只新鲜尸体小腿和足的标本，利用插入踝关节间隙内的压敏片，测定踝关节完整时及后踝分别切除１／４、１／３、１／２时，踝关节内的负重接触区面积，并分析压敏片着色图形的特征。结果电脑计算出踝关节负重区面积为（３．９３±０．３０）ｃｍ２；后踝切除１／４时负重区面积为（３．４２±０．３８）ｃｍ２，两者有非常显著性差异（Ｐ＜０．０１）。随着后踝切除骨片的增大，负重区面积均明显缩小。压敏片图形显示两块蝶形翅膀逐渐融合，中间凹陷变浅，连接处增宽。结论后踝骨折块达关节面１／４时，须作内固定恢复踝关节完整负重区。压敏片图形提示后踝骨片增大时，阻碍了负重区中间关节液正常流动，使软骨营养受到影响。这可能是早期骨关节炎发生的原因之一。Objective To understand the effect of the posterior malleolar fracture on the loading area and image of the loading contact area in the ankle so as to determine the operative indication. Methods Seven lower legs from fresh cadaver were loaded and their loading contact areas in the intact ankle, and respectively at one-fourth, one-third and one-half of the total articular surface removed were determined by pressure sensitive films inserted into the gaps of the joints. The characteristics of the image of the film coloured were analysed. Results At the intact ankle the loading area was (3.90.30) cm2 calculated by the computer; at one-fourth articular surface removed, it was (3.420.38) cm2. There were significant differences (P<0.01) between the data of the two groups. With increasing size of the fragment of the posterior malleolus removed, the loaded contact area of the joint surface was significantly diminished. The two wings of the butterfly in the image of the pressure sensitive film were gradually joined together. Between two wings, the hollow was becoming shallow and the joint site was widened. Conclusions It is necessary that the internal fixation be performed to recover the intact loading area of the ankle while the fracture fragment reaches at one-fourth articular surface. The image of the pressure sensitive film showes that the normal flow of the synovial fluid in the middle of the loading area and the nutrition of the cartilage from it are prevented with the increased size of the posterior malleolar fragment. This can be one of the etiologies that cause the early osteoarthritis.

关 键 词：后踝骨折 骨关节炎 负重区 实验研究 

分 类 号：R683.42[医药卫生—骨科学]