骺板未闭的青少年距腓前韧带修复术中锚钉置入位置及长度的三维CT研究  

Three-dimensional CT study on the position and length of anchor placement during anterior talofibular ligament repair in adolescents with unclosed epiphyseal plates

作　　者：王颉 陈明亮 谷成毅 田志鹏[1] 周游 Wang Jie;Chen Mingliang;Gu Chengyi;Tian Zhipeng;Zhou You(Department of Orthopaedics,Affiliated Renhe Hospital of China Three Gorges University,Sports Medicine Research Institute of China Three Gorges University,Clinical Medical Research Center of Yichang Sports Injury and Repair,Yichang 443001,China)

机构地区：[1]三峡大学附属仁和医院骨科,三峡大学运动医学研究所,宜昌市运动损伤与修复临床医学研究中心,宜昌443001

出　　处：《中华骨科杂志》2025年第5期288-293,共6页Chinese Journal of Orthopaedics

摘　　要：目的通过在三维CT片中测量相关数据探讨骺板未闭的青少年距腓前韧带(anterior talofibular ligament,ATFL)修复术中锚钉置入位置及长度。方法选取2017年1月1日至2024年1月1日三峡大学附属仁和医院放射中心数据库中100例骺板未闭青少年患者的踝关节三维CT照片,男69例、女31例,年龄为(12.38±0.90)岁(范围11~14岁),左侧47例、右侧53例,身高为(155.72±5.84)cm(范围145~175 cm)、体重为(48.02±5.93)kg(范围40~72 kg)、体质指数(body mass index,BMI)为(19.77±1.61)kg/m 2(范围17.69~24.91 kg/m 2)。使用影像归档与通信系统(picture archiving and communication system,PACS)内置测量工具测量置钉方向与腓骨干纵轴的夹角(α)、置钉点与腓骨后缘的距离(d),以及置钉点至腓骨尖水平的高度(h),以评估锚钉置入的位置及长度。结果青少年患者α为47.50°±3.28°(范围40.00°~56.00°),d为(17.12±1.80)mm(范围11.70~21.90 mm),h为(5.21±1.17)mm(范围3.40~7.90 mm)。其中男性患者α、d和h分别为47.48°±3.13°(范围42.00°~56.00°)、(17.49±1.54)mm(范围14.45~21.90 mm)和(5.25±1.07)mm(范围3.70~7.90 mm),女性患者分别为47.55°±3.66°(范围40.00°~53.00°)、(16.30±2.07)mm(范围11.65~20.30 mm)和(5.07±1.56)mm(范围3.40~7.00 mm),男性与女性患者d的差异有统计学意义(t=3.193,P=0.002),而α和h的差异无统计学意义(t=0.098,P=0.922;t=0.296,P=0.770)。结论骺板未闭的青少年ATFL解剖修复术中锚钉置入的安全范围为在腓骨尖上方约3.40~7.90 mm并与腓骨干纵轴成56°~90°角,男性骺板未闭患者宜选择长14 mm及以下的锚钉、女性宜选择长10.8 mm的锚钉。ObjectiveTo explore the position and length of anchor placement during the repair of anterior talofibular ligament(ATFL)in adolescents with unclosed epiphyseal plates by measuring the relevant data in three-dimensional CT.MethodsA total of 100 three-dimensional CT images of adolescent patients with unclosed epiphyseal plates were collected from the database of the Radiology Center of Renhe Hospital Affiliated to China Three Gorges University from January 1,2017 to January 1,2024.There were 69 males and 31 females,aged 12.38±0.90 years(range,11-14 years),47 on the left side and 53 on the right side,with a height of 155.72±5.84 cm(range,145-175 cm),a weight of 48.02±5.93 kg(range,40-72 kg),and a body mass index(BMI)of 19.77±1.61 kg/m 2(range,17.69-24.91 kg/m 2).The built-in measurement tool of the picture archiving and communication system(PACS)was used to measure the angle(α)between the direction of the nail placement and the longitudinal axis of the fibula,the distance between the nail placement point and the posterior edge of the fibula(d),and the height from the nail placement point to the level of the fibula tip(h)to evaluate the position and length of the anchor placement.ResultsIn adolescent patients,αwas 47.50°±3.28°(range,40.00°-56.00°),d was 17.12±1.80 mm(range,11.70-21.90 mm),and h was 5.21±1.17 mm(range,3.40-7.90 mm).Theα,d and h of male patients were 47.48°±3.13°(range,42.00°-56.00°),17.49±1.54 mm(range,14.45-21.90 mm)and 5.25±1.07 mm(range,3.70-7.90 mm),respectively.Those of female patients were 47.55°±3.66°(range,40.00°-53.00°),16.30±2.07 mm(range,11.65-20.30 mm)and 5.07±1.56 mm(range,3.40-7.00 mm),respectively.There was a significant difference in d between male and female patients(t=3.193,P=0.002),but there was no significant difference inαand h(t=0.098,P=0.922;t=0.296,P=0.770).ConclusionsThe safe range of anchor placement during ATFL anatomical repair in adolescents with unclosed epiphyseal plates is about 3.40-7.90 mm above the tip of fibula and 56°-90°with the long

关 键 词：青少年 踝损伤 韧带 腓骨 生长面 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学]