Lauge-Hansen旋后-内收型Ⅱ度踝关节骨折的CT影像解剖学特点及手术治疗  

Imaging anatomy characters and surgery treatment of gradeⅡsupination-adduction ankle joint fractures

作　　者：鹿亮 刘彬 张雨 尚希福 洪浩[3] 曾建学 董凯旋 陈伟健 李多玉 俞光荣[3] Lu Liang;Liu Bin;Zhang Yu;Shang Xifu;Hong Hao;Zeng Jianxue;Dong Kaixuan;Chen Weijian;Li Duoyu;Yu Guangrong(Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), Hefei 230000, China;Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China;Department of Foot and Ankle Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China)

机构地区：[1]中国科技大学附属第一医院(安徽省立医院骨科),合肥230000 [2]南京大学医学院附属南京鼓楼医院成人关节重建与运动医学科,南京210008 [3]同济大学附属同济医院足踝外科,上海200065

出　　处：《中华解剖与临床杂志》2019年第2期106-111,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的总结Lauge-Hansen旋后-内收型Ⅱ度踝关节骨折的CT影像解剖学特点,为临床手术治疗方法的选择提供参考。方法回顾性分析中国科技大学附属第一医院(安徽省立医院)骨科2014年6月—2017年12月收治的36例Lauge-Hansen旋后-内收型Ⅱ度踝关节骨折患者的临床资料,其中男24例、女12例,年龄19~56岁;左踝21例,右踝15例。所有患者行切开复位支撑钢板内固定术,8例合并骨缺损者予一期植骨。应用人体三维可视化手术规划与仿真系统软件(V1.0.0)对患者术前骨折CT影像学资料进行处理,测量以下指标:内踝骨折面与胫骨纵轴的夹角(α)、胫骨远端关节面塌陷的最大深度(d)、塌陷面积(S)、塌陷体积(V)和腓骨骨折线与胫骨远端关节面穹隆顶点的距离(L),分析d、V与α的相关性,总结Lauge-Hansen旋后-内收型踝关节骨折的影像解剖学特征。采用美国骨科足踝协会(AOFAS)踝关节-后足评分标准和术后疼痛视觉模拟评分(VAS)评价治疗效果。结果术前CT影像测量结果显示,本组36例患者α为4.5°~15.5°(9.85°±4.05°),其中20例胫骨远端关节面塌陷患者α为5.04°±1.49°,明显小于16例未塌陷患者α(12.83°±2.87°),两组差异有统计学意义(t=-9.847, P<0.05);20例胫骨远端关节面塌陷患者d、S、V分别为(8.86±3.69)mm,(47.69±13.95)mm^2和(680±620)mm^3,关节面塌陷集中在前内侧,且d、V与α角无明显相关性(rs=0.309、0.389, P值均>0.05)。36例患者腓骨骨折线主要发生在胫骨穹隆最高点以上,L为1.27~12.55(5.50±5.54)mm。所有术后随访时间10(6~15)个月,骨折均解剖复位并完全愈合,愈合时间10.5(9~16)周,术后AOFAS评分和VAS分别为(85±8)分和(2.1±0.9)分。结论Lauge-Hansen旋后-内收型Ⅱ度踝关节骨折患者的内踝骨折线与胫骨的夹角较小,骨折线与胫骨纵轴越接近平行,提示合并胫骨远端内侧关节面塌陷的可能性越大;该型骨折剪切力较大,手术治疗以切开复位支�Objective To define the imaging characters and effective surgery treatment of stageⅡsupination-adduction type ankle fractures. Methods From June 2014 to December 2017 in the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital), 36 patients (24 males and 12 females) with stageⅡsupination-adduction type ankle fractures (21 left ankles and 15 right ankles) ranged from 19 to 56 years old. All patients accepted the treatment of open reduction and internal fixation with buttres plate, and eight patients who also suffered bone defect were treated with bone transplantation. Before operation, all imaging data, including X-ray and computerized tomography(CT) examination, were analyzed the angle (α) between fracture surface and tibia longitudinal axis, the distance (d) from fracture zone to arched roof of tibia distal end joint surface, and area (S) and volume (V) of collapse joint surface, and the relationship between them with three dimension (3D) visualization operation and simulation software system (V1.0.0). The distance (L) between fracture line of fibula and arched roof of tibia distal end joint surface was also measured. The correlation analysis between d, V and α were performed. And then all data were used to analyzed the imaging characters of stageⅡsupination-adduction type ankle fractures. After operations, the results were evaluated with AOFAS and VAS. Results From the pre-operation results of CT imaging of 36 patients,α angle was 4.5°-15.5°(9.85°±4.05°). And α angle of 20 other patients with collapse of tibia distal end joint surface was 9.85°±4.05°, which was significant smaller than that of the other 16 patients without collapse (12.83°±2.87°)(t=-9.847, P<0.05). The d, S and V of 20 patients with collapse of tibia distal end joint surface were (8.86±3.69) mm,(47.69±13.95) mm^2, and (680±620) mm^3 respectively, and the collapse position concentrated on anteromedial ankle joint.Neither d nor V had significant correction to α(rs=0.309, 0.3

关 键 词：踝关节 骨折 骨折固定术 内 旋后内收型踝关节骨折 放射解剖学 

分 类 号：R687.4[医药卫生—骨科学] R816.8[医药卫生—外科学]