外踝Danis-Weber B型骨折的三维形态学研究及临床意义  

Three-dimensional morphology of lateral malleolar fractures of Danis-Weber type B and its clinical implications

作　　者：王伟斌[1] 张世民 Wang Weibin;Chang Shimin(Department of Orthopaedic Trauma,Ningbo No.2 Hospital,Ningbo 315010,China;Department of Orthopaedic Surgery,Yangpu Hospital,Tongji University,Shanghai 200090,China)

机构地区：[1]宁波市第二医院创伤骨科,宁波315010 [2]同济大学附属杨浦医院骨科,上海200090

出　　处：《中华创伤骨科杂志》2023年第9期792-798,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81772323)。

摘　　要：目的描述外踝Danis-Weber B型骨折的形态特征,重点观察骨折尖峰位置的分布情况,并描绘其骨折线地图,以期为临床治疗提供参考。方法回顾性分析2017年1月至2022年5月期间同济大学附属杨浦医院采用手术治疗的114例外踝Danis-Weber B型骨折患者CT断层扫描数据。男46例,女68例;年龄61.5(51.8,68.0)岁。在CT三维重建上测量远端骨块形态,观察骨折尖峰位置,根据尖峰位置将骨折分为4型:Ⅰ型尖峰位于外侧嵴,Ⅱ型尖峰位于后外侧面,Ⅲ型尖峰位于后侧嵴,Ⅳ型尖峰位于内侧面。并将所有骨折线重叠至模板骨上生成三维骨折线地图。结果本组患者按骨折尖峰所在位置分型:Ⅰ型7例(6.1%,7/114),Ⅱ型65例(57.0%,65/114),Ⅲ型39例(34.2%,39/114),Ⅳ型3例(2.6%,3/114)。49例(43.0%,49/114)患者骨折尖峰不在腓骨的后外侧面上(常规后外侧钢板不能压住骨折尖峰)。在骨折形态上,114例患者的前侧骨折高度、后侧骨折高度、骨折垂直长度、骨折倾斜角度、骨折螺旋角度、骨折尖峰螺旋角度分别为(-6.22±4.62)mm、(27.23±12.32)mm、(33.45±11.89)mm、56.9°±9.6°、269.8°±37.1°、156.2°±24.0°。Ⅲ型骨折患者的前侧骨折高度、后侧骨折高度、骨折垂直长度、骨折螺旋角度及骨折尖峰螺旋角度均显著大于Ⅱ型骨折患者,差异均有统计学意义(P<0.05)。骨折线地图提示Ⅲ型骨折的骨折线走行较Ⅱ型骨折更陡峭。结论约有一半的外踝Danis-Weber B型骨折尖峰不在腓骨后外侧面,现有后外侧钢板不能起到有效的抗滑作用。骨折线越高,其骨折尖峰位置越靠近腓骨后内区域(后侧嵴及内侧面)。Ⅲ型和Ⅳ型骨折往往提示更严重的受伤暴力及伴随损伤。Objective To characterize the 3-D morphology of lateral malleolar fractures of Danis-Weber type B,especially the distribution of fracture apexes,for formulation of 3-D maps of fracture lines which may facilitate the treatment of the fractures.Methods A retrospective study was conducted to analyze the CT tomography data of 114 patients who had been operatively treated for lateral malleolar fractures of Danis-Weber type B at Department of Orthopaedic Surgery,Yangpu Hospital from January 2017 to May 2022.There were 46 males and 68 females with a mean age of 61.5(51.8,68.0)years.The morphology of distal bone blocks was measured and positions of fracture apexes were observed on 3-D CT reconstruction.According to the positions of apex,the fractures were divided into 4 types:typeⅠwith the apex located on the lateral ridge,typeⅡwith the apex located on the posterolateral side,typeⅢwith the apex located on the posterior ridge,and typeⅣwith the apex located on the medial side.CT images of all fractures were superimposed on a standard template to create 3-D fracture line maps.Results In this cohort,there were 7 cases of typeⅠ(6.1%,7/114),65 cases of typeⅡ(57.0%,65/114),39 cases of typeⅢ(34.2%,39/114)and 3 cases of typeⅣ(2.6%,3/114).In 49 cases(43.0%,49/114),the fracture apex was not located on the posterolateral fibula(so that a conventional posterolateral steel plate cannot compress the apex).In fracture morphology of the 114 patients,the anterior fracture height,posterior fracture height,vertical fracture length,inclination angle,spiral angle,and apex spiral angle were,respectively,(-6.22±4.62)mm,(27.23±12.32)mm,(33.45±11.89)mm,56.9°±9.6°,269.8°±37.1°,and 156.2°±24.0°.The anterior fracture height,posterior fracture height,vertical fracture length,inclination angle,spiral angle,and apex spiral angle in typeⅢwere all significantly larger than those in typeⅡ(P<0.05).The 3-D fracture line maps indicated that the lines of typeⅢfracture were steeper than those of typeⅡfracture.Conclusions Sin

关 键 词：踝关节 外踝骨折 B型骨折 形态学 骨折线地图 

分 类 号：R687.3[医药卫生—骨科学]