摘要
目的探讨无内踝骨折的Weber B型踝关节骨折术前影像与术中应力试验的特点及临床价值。方法回顾性分析2018年1月至2021年12月期间北京积水潭医院创伤骨科收治的52例无内踝骨折的Weber B型踝关节骨折患者资料。根据术中应力试验的结果分为两组:阳性组21例, 男19例, 女2例;年龄为(34.4±10.2)岁;术中应力试验结果呈阳性。阴性组31例, 男22例, 女9例;年龄为(39.5±14.8)岁;术中应力试验结果呈阴性。比较两组患者术前X线片上内踝间隙、下胫腓间隙、腓骨骨折线垂直长度, 以及术前CT片上后踝骨折块的相对大小, 观察患者术中应力试验的影像特点。结果两组患者术前一般资料的比较差异均无统计学意义(P>0.05), 具有可比性。阳性组患者内踝间隙[(7.2±2.5)mm]、腓骨骨折线垂直长度[49.2(33.7, 58.7)mm]均显著大于阴性组患者[(4.5±1.7)、29.6(24.7, 36.0)mm], 差异均有统计学意义(P<0.05)。而两组患者的下胫腓间隙[(6.0±1.9)mmvs.(5.2±1.4)mm)]、CT片上后踝骨折块相对大小[15.8%(6.9%, 19.1%)vs. 12.7%(0%, 18.9%)]比较差异均无统计学意义(P>0.05)。两组患者共收集到22例术中应力试验影像资料(阳性组和阴性组各11例), 其中7例患者应力试验中仅内踝间隙增宽而下胫腓间隙未增宽(阳性组5例, 阴性组2例)。结论无内踝骨折的Weber B型踝关节骨折在固定外踝后有时仍存在不稳定, 建议常规行应力试验。伤后X线片上内踝间隙较宽、腓骨骨折线较长的患者可能更容易出现外踝固定后的不稳定。无内踝骨折的Weber B型踝关节骨折患者术中应力试验易出现内踝间隙增宽而下胫腓间隙未增宽的现象, 此时是否有必要固定下胫腓联合需进一步研究。
Objective:To explore the characteristics and clinical values of preoperative imaging signs and intraoperative stress test in the surgery of the Weber type B fracture without medial malleolar fracture.Methods:The data of 52 patients were reviewed who had been treated at Orthopaedic Trauma Department, Beijing Jishuitan Hospital for Weber type B ankle fracture without medial malleolar fracture from January 2018 to December 2021.They were assigned into 2 groups depending on their results of intraoperative stress test. In the positive group of 21 cases showing a positive intraoperative stress test, there were 19 males and 2 females with an age of (34.4±10.2) years;in the negative group of 31 cases showing a negative intra operative stress test, there were 22 males and 9 females with an age of (39.5±14.8) years. The 2 groups were compared in terms of the medial clear space, tibiofibular clear space and vertical length of the fibular fracture on the preoperative X-ray film, as well as the relative size of the posterior malleolar fracture fragment on the preoperative CT. The imaging characteristics of intraoperative stress tests were also observed.Results:There was no significant difference between the 2 groups in the preoperative general data, showing comparability between groups ( P>0.05). The medial clear space (7.2±2.5) mm and the vertical length of the fibular fracture [49.2 (33.7, 58.7) mm] in the positive group were significantly larger than those in the negative group [(4.5±1.7) mm and 29.6 (24.7, 36.0) mm] ( P<0.05). There was no significant difference between the 2 groups in the lower tibiofibular space [(6.0±1.9) mm versus (5.2 ± 1.4) mm] or in the relative size of posterior malleolar fracture measured by CT [15.8% (6.9%, 19.1%) versus 12.7% (0%, 18.9%)] ( P>0.05). The intraoperative stress test imaging data of a total of 22 cases were collected from the 2 groups (11 cases from each of the 2 groups). During the stress test, only the medial clear space was widened with no widening of the inferior tibiofibular space was found in 7 cases (5 cases in the positive group and 2 cases in the negative group). Conclusions:A routine stress test is recommended for Weber B ankle fracture without medial malleolus fracture, because instability sometimes exists after fibular fixation. Patients with a wider medial clear space and a longer fibular fracture line on X-ray after injury are more likely to be afflicted by instability after fibular fixation. In the patients with a widened medial clear space but without a widened inferior tibiofibular clear space during an intraoperative stress test, it calls for further study whether it is necessary to fix the inferior tibiofibular joint.
作者
费晗
李庭
李长润
孙志坚
孙旭
肖鸿鹄
米萌
姚东晨
公茂琪
Fei Han;Li Ting;Li Changrun;Sun Zhjian;Sun Xu;Xiao Honghu;Mi Meng;Yao Dongchen;Gong Maoqi(Orthopaedic Trauma Department,Beijing Jishuitan Hospital,,Bejing 100035,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2022年第12期1063-1068,共6页
Chinese Journal of Orthopaedic Trauma
基金
首都卫生发展科研专项(首发2022-2-1121)。
关键词
踝关节
骨折
影像学测量
应力试验
Ankle joint
Fractures,bone
Imaging measurement
Stress test
