成人后踝骨折夹层骨块的特征  

Characteristics of intercalary fragment of posterior malleolus fractures in adults

作　　者：王建卫[1] 黄路[1] 章相锋[1] 胡东才 潘志军[1] Wang Jianwei;Huang Lu;Zhang Xiangfeng;Hu Dongcai;Pan Zhijun(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2019年第5期291-297,共7页Chinese Journal of Orthopaedics

基　　金：浙江省自然科学基金(LY18H060002);国家自然科学基金(81601964).

摘　　要：目的统计成人踝关节骨折中后踝夹层骨块的发生率、形态特征及与后踝骨折类型的关系。方法回顾性研究2014年1月至2016年1月369例成人踝关节骨折患者资料,其中247例有后踝骨折,男109例,女138例;年龄18~85岁,平均(48.87±16.35)岁。分析247例患者术前X线片及CT资料,统计后踝夹层骨块的发生率;将后踝夹层骨块按位置(外1/3、中1/3和内1/3)、大小(矢状径< 2 mm、2~5 mm和>5 mm)及形态(游离、折叠、压缩骨块)分类,描述其形态特征;将后踝骨折按照Bartonícek分型,研究后踝夹层骨块与后踝骨折类型的关系;以分离>2 mm,或有>2 mm的台阶为标准,统计术后复位不良率。结果 247例后踝骨折中有106例有后踝夹层骨块,后踝骨折的夹层骨块发生率为42.91%(106/247),踝关节骨折夹层骨块的发生率为28.73%(106/369),其中矢状径>2 mm的夹层骨块为81例,其在后踝骨折中的发生率为32.79%(81/247),>5 mm的夹层骨块33例,其在后踝骨折中的发生率为13.36%(33/247)。64.15%(68/247)的夹层骨块发生在外1/3。247后踝骨折中,BartonícekⅠ型22例(8.91%,22/247),Ⅱ型122例(49.39%,122/247),Ⅲ型54例(21.86%,54/247),Ⅳ型49例(19.84%,49/247);Ⅰ型后踝骨折夹层骨块的发生率为4.54%(1/22),Ⅱ型40.16%(49/122),Ⅲ型70.37%(38/54),Ⅳ型36.73%(18/49),Ⅲ型后踝骨折夹层骨块发生率明显高于其他类型后踝骨折的夹层骨块发生率。43例夹层骨块矢状径>2 mm的患者术后行CT检查,其中19例复位不良,占44.19%(19/43)。结论后踝夹层骨块在后踝骨折中具有较高的发生率,绝大部分夹层骨块分布在后外侧,Bartonícek Ⅲ型后踝骨折中夹层骨块的发生率最高。Objective To investigate the incidence of intercalary fragment in adult ankle fractures and analyze the morphological characteristics of intercalary fragment as well as its relationship with the type of posterior malleolus fractures. Methods Data of 247 cases with posterior malleolus fractures from 369 cases of adult ankle fractures who were treated from January 2014 to January 2016 were retrospectively analyzed. The pre-operative X-ray and CT data of the group were analyzed, and the incidence of intercalary fragment was measured. The intercalary fragment was classified by position, size and shape of its morphological features. The posterior malleolus fracture was classified according to Bartonícek classification system. The relationship between type of posterior malleolar fracture and the intercalary fragment was studied. The incidence of malreduction was also studied using the criterion of more than 2 mm separation or step. Results One hundred and six cases had intercalary fragment, accounting for 42.91%(106/247) of the posterior malleolus fracture, and 28.73%(106/369) of all ankle fractures. There were 81 cases with intercalary fragment larger than 2 mm, accounting for 32.79%(81/247) of the posterior malleolus fracture. There were 33 cases with intercalary fragment larger than 5 mm, accounting for 13.36%(33/247) of the posterior malleolus fracture. The incidence of intercalary fragment occurred in the posterolateral side was 64.15%(68/247). According to Bartonícek classification, the incidence of type I, II, III, and Ⅳ posterior ankle fracture was 8.91%(22/247), 49.39%(122/247), 21.86%(54/247), and 19.84%(49/247), respectively. The incidence of intercalary fragment was 4.54%(1/22) in type I posterior ankle fractures, 40.16%(49/122) in type II, 70.37%(38/54) in type III, and 36.73%(18/49) in type IV. The incidence in type III posterior malleolus fracture was significantly higher than that of other types of posterior malleolus fracture. CT scan after operation was conducted in 43 cases in which 19 cases had

关 键 词：成年人 踝关节 骨折 

分 类 号：R687.3[医药卫生—骨科学]