胫骨后踝骨折块形态学分析及内固定策略  

A study on the morphology characteristics of posterior malleolus fracture and Inter-fixation strategy

作　　者：张妙林[1] 高志朝[1] 郑俊[1] 孟永俊[1] 郑国富[1] 

机构地区：[1]浙江省杭州市余杭区第一人民医院,杭州311100

出　　处：《浙江创伤外科》2017年第2期216-219,共4页Zhejiang Journal of Traumatic Surgery

基　　金：杭州市余杭区科技局基金(编号:医疗卫生2014-015);卫生部医药卫生发展计划(编号:W2014ZT317)

摘　　要：目的探讨胫骨后踝关节面骨折在胫骨远端骨折中的发生率及形态学特征,并根据形态学特征确定内固定策略。方法回顾性分析2010年3月至2014年12月共207例胫骨远端骨折涉及关节面的患者的CT图像及临床资料。其中52例CT图像缺失或不兼容影像存储和传输系统予排除。155例纳入研究。研究胫骨后踝骨折块在胫骨远端关节面骨折中的发生率,并测量骨折块占关节面面积、骨折块高度、移位程度等形态学数据。结果在155例胫骨远端骨折中发现36例存在后踝骨折块,发生率为23.2%(36/155)。其中男21例,女15例;年龄34~75岁,平均54.6岁;致伤原因:交通伤22例,扭伤10例,重物挤压伤4例。受累的后踝骨折块面积占整个胫骨远端面积的24%,后踝骨折块的高度为12~39mm,平均26.5mm;后踝骨折块平均水平移位1~15mm,平均10.5mm,平均垂直移位1~12mm,平均6.3mm。结论胫骨后踝骨折在胫骨远端关节骨折中发生率为23.2%,骨折块均存在不同程度的移位,骨折块所累及的关节面面积较大。Objective To study on the morphology character of posterior malleolus fracture using CT scan,and then apply the data to guide the inter-fixation strategy. Methods A retrospective study was done on 207 patients with dislal tibial fracture, 52 cases were exelued for less CT scan image or discompatibility of PACS . Another 155 cases were replyed CT scan.To analyse the occurrence rate of posterior malleolus fracture in distal tibial fracture, measure morphological parameters such as the area of the posterior malleobts fracture,the height of fracture fragment,the disloca- tion degree of fracture fragment. Results 36 cases of posterior malleolus fracture were found in 155 cases of distal tibial fracture with the 23.2% incidenee（36/155）.There were 21 males and 15 females,aged from 34-75 years（mean54.6 years）.The mechanism of iniury were traffic accident in 22 patients,blow by heavy object in 4 patients,wrench in 10 patients. The posterior malleolus fracture fragment hadmorphological characteristics of irregular, and an average accounted for 24% of the articular surface of the total distal tibial articular surface. The maximum posterior malleolus fracture fragment height was 26.5 mm （range12-39mm）,and average size of the anterior-posterior displacement was 10.5mm（rangel-15mm）,and average size of the vertical displacement was 6.3mm （rangel-12mm）. Conclusion The posterior malleolus fracture fragment hadmorphological characteristics of a conical shape fragment,relative major articular surface area and obvious displacement.

关 键 词：踝损伤 后踝骨折 体层摄影术 内固定 

分 类 号：R687.3[医药卫生—骨科学]