Lauge-Hansen旋前外展Ⅲ度踝骨折特点及下胫腓联合复位情况分析  

Characteristics of pronation abduction Lauge-Hansen stage Ⅲ malleolus fracture and inferior tibiofibular syndesmosis reduction quality

作　　者：李猛 王巨鹏 赵成礼 李楠[2] 康宇翔 辛景义[2] 孙振辉[2] LI Meng;Wang Ju-peng;ZHAO Cheng-li;LI Nan;KANG Yu-xiang;XIN Jing-yi;SUN Zhen-hui(Department of Orthopaedics,Tianjin Xiqing Hospital,Tianjin 300380,China;Foot and Ankle Department of Orthopaedics,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市西青医院,天津300380 [2]天津医院足踝外科,天津300211

出　　处：《创伤外科杂志》2020年第3期188-192,共5页Journal of Traumatic Surgery

摘　　要：目的探讨Lauge-Hansen旋前外展III度踝骨折(PA-Ⅲ度踝骨折)特点和下胫腓联合(ITFS)复位质量。方法回顾性分析2015年4月—2016年10月天津医院足踝外科入院诊断为PA-Ⅲ踝骨折患者52例,男性44例,女性8例;年龄15~74岁,平均37.7岁;右踝18例,左踝34例。由1名主治医师阅读伤后踝X线片并作出诊断,主任医师联合三维CT观察踝骨折特点修正诊断,对比分析误诊组和确诊组内踝骨折、Tillaux结节骨折及下胫腓联合分离、外踝骨折部位、类型、主要骨折线方向和主要骨折块位置。术后X线及CT确定ITFS复位质量,间隙与胫距间隙差值>2mm确定为复位不良。结果52例患者根据伤后X线检查确诊为PA-Ⅲ度踝骨折,三维CT分析踝骨折特点后证实21例误诊,误诊率40.38%。两组在内踝骨折、外踝骨折、Tillaux结节骨折及下胫腓联合分离比较差异无统计学意义(P>0.05);两组在外踝骨折类型、主要骨折线方向、主要骨折块位置比较差异有统计学意义(P<0.05),在外踝骨折平面比较差异无统计学意义(P>0.05)。确诊组患者中术后ITFS复位不良7例(22.6%)。结论单纯依靠X线片诊断PA-Ⅲ度踝骨折误诊率较高,CT三维重建观察外踝骨折类型、主要骨折线方向和骨折块位置可辅助确诊。PA-Ⅲ度踝骨折术后ITFS复位不良发生率较高。Objective To investigate the characteristics of Lauge-Hansen pronation abduction Ⅲ-degree ankle fracture( PA-Ⅲ-degree ankle fracture) and analyze the reduction of inferior tibiofibular syndesmosis( ITFS).Methods A retrospective analysis was conducted in 52 patients diagnosed with PA-Ⅲ degree ankle fractures admitted to Tianjin Hospital from Apr. 2015 to Oct. 2016. There were 44 males and 8 females;their age ranged from15 to 74 years,with an average of 37. 7 years. There were 18 cases of right ankle injury and 34 cases of left ankle injury. An attending physician read and diagnosed the ankle X-ray film after injury,and the chief physician observed the characteristics of the ankle fracture to correct the diagnosis with the help of 3 D CT. The misdiagnosed group and the diagnosed group were compared and analyzed for medial malleolus fracture,Tillaux nodular fracture,joint tibiofibular separation,lateral malleolus fracture location,type,major fracture line direction and major fracture block location. X-ray and CT were used to determine the quality of ITFS reduction,and the difference between the gap and tibial gap was greater than 2 mm. Results Fifty-two patients were diagnosed as PA-Ⅲ ankle fractures by X-ray examination after injury. Three-dimensional CT analysis of ankle fractures confirmed 21 cases of misdiagnosis,with a misdiagnosis rate of 40. 38%. There was no significant difference in the medial malleolus fracture,lateral malleolus fracture,Tillaux nodular fracture,and ITFS separation between the two groups( P > 0. 05). There were differences in the types of lateral malleolus fractures,the direction of major fracture lines,and the location of major fracture blocks,with a statistical significance( P < 0. 05). There was no significant difference in the lateral malleolus fracture plane( P > 0. 05). Seven patients( 23%) had poor ITFS reduction in the confirmed group. Intraoperative approach can be used to reduce the lower tibiofibular joint under direct vision to avoid poor reduction. Conclusion The misdi

关 键 词：踝骨折 诊断 影像检查 复位 

分 类 号：R683.42[医药卫生—骨科学]