[1]陈诚,成永忠,程灏,等.旋后-外旋型三踝骨折的筋骨结构关系研究[J].中医正骨,2016,28(01):6-9.
　CHEN Cheng,CHENG Yongzhong,CHENG Hao,et al.Study on the structural relationship of supination-extorsion-type trimalleolar fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(01):6-9.
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旋后-外旋型三踝骨折的筋骨结构关系研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年01期
页码:
6-9
栏目:
临床研究
出版日期:
2016-01-20

文章信息/Info

Title:
Study on the structural relationship of supination-extorsion-type trimalleolar fractures
作者:
陈诚; 成永忠; 程灏; 侯汪洋; 温建民; 蔡静怡
中国中医科学院望京医院,北京 100102
Author(s):
CHEN Cheng; CHENG Yongzhong; CHENG Hao; HOU Wangyang; WEN Jianmin; CAI Jingyi
Wangjing Hospital of China Academy Of Chinese Medical Sciences,Beijing 100102,China
关键词:
踝关节;  踝损伤;  正骨手法;  相关分析
Keywords:
ankle joint;  ankle injuries;  bone setting manipulation;  correlation analysis
摘要:
目的:探讨旋后-外旋型三踝骨折的筋骨结构关系。方法:选择41例旋后-外旋型三踝骨折患者,拍摄踝关节正、侧位X线片,采用Image Pro Plus 6.0软件在X线片上测量外踝向外移位距离、外踝向后移位距离、外踝短缩距离、内踝向下移位距离、内踝向外移位距离、后踝向上移位距离及距骨倾斜角,并分析内、外、后踝移位距离与距骨倾斜角的相关性。结果:本组患者外踝向外移位距离、外踝向后移位距离、外踝短缩距离、内踝向下移位距离、内踝向外移位距离、后踝向上移位距离及距骨倾斜角分别为(3.50±2.09)mm、(3.09±2.02)mm、(5.26±3.36)mm、(6.03±5.07)mm、(2.91±3.09)mm、(2.66±2.30)mm、(5.09°±4.25°)。经相关分析,距骨倾斜角与外踝向外移位距离、外踝短缩距离、内踝向下移位距离、内踝向外移位距离均呈正相关(r=0.430,P=0.050; r=0.666,P=0.000; rs=0.561,P=0.000; rs=0.360,P=0.021),与外踝向后移位距离、后踝向上移位距离不存在相关关系(r=-0.115,P=0.473; rs=0.174,P=0.276)。以距骨倾斜角为因变量,以外踝向外移位距离、外踝短缩距离、内踝向下移位距离、内踝向外移位距离为自变量,最终建立的回归方程为:距骨倾斜角=0.269+0.462×内踝向下移位距离+0.597×外踝短缩距离-0.379×内踝向外移位距离,内踝向下移位距离、外踝短缩距离、内踝向外移位距离的标准化系数分别为0.551、0.472、-0.275。结论:旋后-外旋型三踝骨折中,距骨移位与内、外踝骨折块移位之间均存在密切的相关性,其中内踝骨折块向下移位与距骨移位的相关性最强。临床应用手法复位旋后-外旋型三踝骨折时,应充分利用距骨与内、外踝骨折块之间紧密的筋骨结构关系,以获得更好的复位效果。
Abstract:
Objective:To explore the relationship between different anatomic structures in supination-extorsion-type trimalleolar fractures.Methods:Forty-one patients with supination-extorsion-type trimalleolar fractures were selected and the anteroposterior and lateral X-rays films were taken.The outward displacement distance,posterior displacement distance and shortening distance of lateral malleolus,downward displacement distance and outward displacement distance of medial malleolus,upward displacement distance of posterior malleolus and talar tilt angle were measured on the X-rays films by using Image Pro Plus 6.0 software,and the correlations between the displacement distance of medial,lateral and posterior malleolus and talar tilt angle were analyzed.Results:The outward displacement distance,posterior displacement distance and shortening distance of lateral malleolus,downward displacement distance and outward displacement distance of medial malleolus,upward displacement distance of posterior malleolus and talar tilt angle were 3.50+/-2.09 mm,3.09+/-2.02 mm,5.26+/-3.36 mm,6.03+/-5.07 mm,2.91+/-3.09 mm,2.66+/-2.30 mm and 5.09+/-4.25 degrees respectively.The results of correlation analysis showed that talar tilt angle was positively correlated with the outward displacement distance and shortening distance of lateral malleolus and downward displacement distance and outward displacement distance of medial malleolus(r=0.430,P=0.050; r=0.666,P=0.000; rs=0.561,P=0.000; rs=0.360,P=0.021),and was not correlated with posterior displacement distance of lateral malleolus and upward displacement distance of posterior malleolus(r=-0.115,P=0.473; rs=0.174,P=0.276).The talar tilt angle was chosen as the dependent variable(Y),while the outward displacement distance(X1)and shortening distance(X2)of lateral malleolus and downward displacement distance(X3)and outward displacement distance(X4)of medial malleolus were chosen as independent variable to establish the regression equation Y=0.269+0.462×X3+0.597×X2-0.379×X4.The standardized coefficients of downward displacement distance of medial malleolus,shortening distance of lateral malleolus and outward displacement distance of medial malleolus were 0.551,0.472 and -0.275 respectively.Conclusion:The displacement of talus is significantly correlated with the displacement of fracture fragments of medial malleolus and lateral malleolus in the supination-extorsion-type trimalleolar fractures,and the most significant correlation exists between the downward displacement of fracture fragments of medial malleolus and displacement of talus.Above closed correlation should be utilized adequately to obtain better results of manual reduction in the treatment of supination-extorsion-type trimalleolar fractures.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81273785); 2012年北京市科学技术委员会首都十大危险疾病科技成果推广项目(Z121100005512013)
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更新日期/Last Update: 2016-02-29