踝穴移位预测外踝骨折复位不良的影像学研究  

Prediction of lateral malleolus malreduction by tibiotalar displacement in ankle fracture： a radiological study

作　　者：陈立[1] 马昕[1] 王旭[1] 黄加张[1] 张超[1] 张益钧[1] 王晨[1] 

机构地区：[1]复旦大学附属华山医院骨科,上海200040

出　　处：《中华创伤骨科杂志》2014年第12期1054-1059,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目（81171670/H0601）

摘　　要：目的 探讨术中透视下踝穴移位的影像学参数在三角韧带完整及离断的情况下判断外踝骨折复位不良的预测能力.方法 采用10具膝关节以下新鲜下肢尸体标本,在三角韧带完整及离断的情况下（n=5）模拟外踝1 mm、2 mm、3 mm的短缩畸形以及10°、20°、30°的旋转畸形.透视踝关节正位片测量内侧踝穴间隙（MCS）、胫距上间隙（SCS）及距骨倾斜角（TT）.分别以MCS≥4 mm、MCS≥SCS、TT≥5°为诊断标准,评估其对外踝骨折复位不良的诊断敏感性.结果 在三角韧带离断组中,3项判断踝穴移位的诊断标准其诊断阳性率均高于三角韧带完整组.MCS≥4 mm在诊断大于2 mm的外踝短缩畸形合并三角韧带离断时有较好的敏感性（敏感性≥0.8）,但对于其他外踝复位畸形敏感性较差（敏感性≤0.2）.MSC≥SCS的诊断敏感性好于其他两项诊断标准.可以发现较轻程度的外踝复位不良,三角韧带离断合并外踝短缩1 mm、外踝短缩2 mm、外踝旋转10°、外踝旋转20°的诊断敏感性分别是0.6、1.0、0.4、0.8.TT≥5°的总体诊断敏感性差于另外两项诊断标准,在外踝短缩2 mm、3 mm并合并三角韧带离断时的敏感性为0.4、0.8,而在其他情况下的诊断敏感性均小于0.2.结论 在三角韧带离断情况下,踝穴移位的影像学参数能够敏感地预测外踝骨折复位不良.以MSC≥SCS为诊断阈值判断踝穴移位相比MSC≥4 mm及TT≥5°能够更敏感地发现可能存在的外踝骨折复位不良.在三角韧带完整情况下,踝穴移位判断外踝复位不良的敏感性较差.Objective To explore the feasibility of predicting lateral malleolus malreduction by radiological parameters of tibiotalar displacement in ankle fracture with or without sectioned deltoid ligament.Methods Ten fresh cadaveric specimens of lower extremity below the knee were used to create shortening malreduction of 1 mm,2 mm and 3 mm and rotational malreduction of the lateral malleolus of 10°,20° and 30°.Medial clear space （MCS）,superior clear space （SCS） and talar tilt angle （TT） were measured on the anteroposterior X-ray films of the ankle.The 3 parameters were evaluated for their diagnostic sensitivity to lateral malleolus malreduction,setting MCS≥4 mm,MCS≥SCS and TT≥5° as diagnostic criteria.Results In the group of sectioned deltoid ligament,the 3 radiological parameters of tibiotalar displacement were more sensitive than in the other group.The sensitivity of MCS ≥4 mm was superior in the specimens with lateral malleolus shortening more than 2 mm and sectioned deltoid ligament （sensitivity ≥ 0.8） but inferior in other kinds of lateral malleolus malreduction.MCS ≥ SCS could discover a subtle lateral malleolus malreduction,with a superior sensitivity compared with the other 2 parameters.Its sensitivity to sectioned deltoid ligament combined with lateral malleolus shortening of 1 mm,lateral malleolus shortening of 2 mm,lateral malleolus rotation of 10° and lateral malleolus rotation of 20° was respectively 0.6,1.0,0.4 and 0.8.The sensitivity of T≥5° was inferior to that of the other 2 parameters.It was 0.4 and 0.8 respectively for sectioned deltoid ligament combined with lateral malleolus shortening of 2 mm and 3 mm,and less than 0.2 for other conditions.Conclusions In the condition of sectioned deltoid ligament,radiological parameters of tibiotalar displacement can be used to predict lateral malleolus malreduction sensitively.The MCS ≥ SCS value may be more sensitive than MCS ≥4 mm and TT≥ 5° as threshold values for diagnosis in discovering tibiotalar displacement.In t

关 键 词：踝关节 骨折 生物力学 影像学研究 

分 类 号：R683[医药卫生—骨科学]