后踝骨折的CT测量及分型后踝骨折的CT测量及分型吴术红刘毅遵义.DOC

后踝骨折的CT测量及分型 吴术红 刘毅 遵义医学院附属医院骨一科 贵州遵义 563003 摘要 目的 探讨后踝骨折的CT分型及其对基础研究和临床处理的作用。方法 在59例后踝骨折的CT片上测量后踝骨折块占整个胫骨远端横断面的面积比、主要骨折线与内外踝之间轴线的夹角，记录每例主要骨折线得走形方向及起止点、主要骨折块的数量、位置等，并根据主要骨折线的走形方向将后踝骨折分型，归纳各型骨折的特征；采集术中复位固定的顺序、后踝骨折块复位情况及是否使用内固定等资料进行归纳总结。结果 后踝骨折可以分为三型：外斜型40例，特征是累及胫骨远端后外侧角的楔形骨块，平均面积比为12.1%，a角平均为21.3度；平行型11例，特征是累及内踝的大面积骨折块，多有两个骨块构成，平均为面积比28.9%，a角平均为7.4度；粉碎型8例，特征是累及后踝多个粉碎性骨折片，骨折线变化范围很大。共有10例面积比大于25%，9例行内固定；21例后踝行内固定术，其中包括9例面积比小于25%外斜型骨折。结论 根据CT测量后踝骨折可以分为三型，外斜型骨折最为常见，尽管骨折块面积多小于25%但仍有部分病例需内固定治疗，建议采用外踝-内踝-后踝的顺序复位；平行型骨折块面积较大，常累及内踝，多需内固定治疗，建议采用外踝-后踝-内踝的顺序复位。使用X线诊断时，外斜型骨折摄侧位片时应平均外旋21度，而平行型骨折应外旋7度。后踝骨折的CT分型为基础研究的骨折模型制作提供截骨方法和依据。 关键词：后踝骨折 CT测量 CT分型 The Types of Posterior Malleolar Fracture Classified by CT Wu Shuhong Liu Yi Department of orthopaedics，affiliated hospital of Zuyi Medical College，Zunyi GuiZhou,56300 Objective To discuss types of posterior malleolar fracture classified by CT and its contribution to fundamental research and clinical procedures. Methods Measured area ratio of posterior malleolar fracture bone and the distal tibia’s cross section, the angle between main fracture line and axis of medial malleolus and lateral malleolus.Got record of where fracture line started and ended, how many fracture bones and where they were based on 59 computerized tomography. Posterior malleolar fracture could be classified according to where main fracture line goes.Thereby, concluded characters of different fracture.Collected information such as the order of reduction of fracture,what posterior malleolar fracture was going on and internal fixation device was needed or not.Therefore, drew a conclusion.Results Posterior malleolar fracture can be classified as three types.40 outward inclination fracture cases, wedge-shaped bones which affected distal tibia,the average area ration was 12.1% and a angle was 21.3 degree.11 parallel fracture cases, large number of fracture bones which affected medial malleolus are mainly composed of two bones.The average area ration wa