术中造影在下胫腓联合损伤诊治中的应用研究  

Application of intraoperative arthrography in diagnosis and treatment of syndesmotic injuries

作　　者：王拯[1] 闫俊[1] 孙建斌[1] 高鹏程 张昊 安维军[1] WANG Zheng;YAN Jun;SUN Jianbin;GAO Pengcheng;ZHANG Hao;AN Weijun(Department of Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院骨科,宁夏银川750004

出　　处：《宁夏医学杂志》2020年第5期422-425,共4页Ningxia Medical Journal

基　　金：宁夏医科大学科学研究基金资助项目(XY2017108)。

摘　　要：目的探讨术中造影在下胫腓联合损伤诊断和判断手术复位固定方面的准确性、有效性及其与CT检查结果的相关性;评价该方法的应用价值。方法本研究共纳入100例单侧踝关节骨折且对侧踝关节正常的患者。所有踝关节骨折患者在术前、术后行双侧踝关节CT检查并在CT的轴位图像上测量双侧下胫腓的宽度,术中进行踝关节造影,根据结果分为造影阳性组、造影阴性组、下胫腓复位后再次造影证实为阴性的验证组;对每组内伤侧与健侧下胫腓间距采用配对t检验进行统计学分析。结果在100例踝关节骨折患者中,42例的造影结果为阴性,该组患者表现为下胫腓处造影剂无泛溢,比较术前伤侧与健侧CT测量的下胫腓宽度,2组间差异无统计学意义(P>0.05),提示宽度无增加。58例的造影结果为阳性,该组患者表现为下胫腓处造影剂泛溢,比较术前伤侧与健侧CT测量下的胫腓宽度,2组间差异有统计学意义(P<0.05),提示宽度明显增加;术中对58例造影结果为阳性的患者进行下胫腓复位固定后再次造影测试结果为阴性,比较术后伤侧与健侧CT测量的下胫腓宽度,2组间差异无统计学意义(P>0.05)。结论术中造影可在术中用于诊断下胫腓联合损伤,是一种准确、有效且客观的检验方式;术中可多次进行试验,以判断下胫腓联合复位固定的准确性。Objective To investigate the accuracy and effectiveness of the intraoperative arthrography in diagnosis of syndesmotic injuries and to judge surgical reduction and fixation during the operation of the syndesmotic injuries,and to evaluate the correlation between preoperative CT scanning and the application value.Methods 100 patients with the unilateral ankle fractures and normal contralateral ankle joints were enrolled in the study.CT examination of bilateral ankle joint was performed in all patients with ankle fracture before and after operation,and intraoperative ankle arthrography was performed on all ankle fractures.Ankles were classified as positive group,negative group and verification group.The width of the syndesmotic region were measured on axial images of the CT.Results The results were negative in 42 ankle fractures.In this group,there was no significant difference between the width of the injured side and the contralateral in preoperative CT.The results were positive in 58 cases,and it showed a significant increase in syndesmotic width.There was a significant difference between the injured side and the contralateral of preoperative CT in this group.After fixation completed,58 patients'the fibula was reduced,and further ankle arthrography verified that the result was negative.There was no significant difference in width between the injured side and the contralateral of postoperative CT in this group.Conclusion The intraoperative arthrography is an accurate,effective and objective test which can be used to diagnose the syndesmotic injuries intraoperatively.The test can be performed multiple times during the operation to determine the accuracy of reduction and fixation.

关 键 词：踝关节造影 踝关节骨折 下胫腓联合损伤 应用 

分 类 号：R687.4[医药卫生—骨科学]