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[1]陳誠(chéng),成永忠,程灝,等.旋后-外旋型三踝骨折的筋骨結(jié)構(gòu)關(guān)系研究[J].中醫(yī)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結(jié)構(gòu)關(guān)系研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年01期
頁(yè)碼:
6-9
欄目:
臨床研究
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:
陳誠(chéng); 成永忠; 程灝; 侯汪洋; 溫建民; 蔡靜怡
中國(guó)中醫(yī)科學(xué)院望京醫(yī)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
關(guān)鍵詞:
踝關(guān)節(jié);  踝損傷;  正骨手法;  相關(guān)分析
Keywords:
ankle joint;  ankle injuries;  bone setting manipulation;  correlation analysis
摘要:
目的:探討旋后-外旋型三踝骨折的筋骨結(jié)構(gòu)關(guān)系。方法:選擇41例旋后-外旋型三踝骨折患者,拍攝踝關(guān)節(jié)正、側(cè)位X線片,采用Image Pro Plus 6.0軟件在X線片上測(cè)量外踝向外移位距離、外踝向后移位距離、外踝短縮距離、內(nèi)踝向下移位距離、內(nèi)踝向外移位距離、后踝向上移位距離及距骨傾斜角,并分析內(nèi)、外、后踝移位距離與距骨傾斜角的相關(guān)性。結(jié)果:本組患者外踝向外移位距離、外踝向后移位距離、外踝短縮距離、內(nèi)踝向下移位距離、內(nèi)踝向外移位距離、后踝向上移位距離及距骨傾斜角分別為(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°)。經(jīng)相關(guān)分析,距骨傾斜角與外踝向外移位距離、外踝短縮距離、內(nèi)踝向下移位距離、內(nèi)踝向外移位距離均呈正相關(guān)(r=0.430,P=0.050; r=0.666,P=0.000; rs=0.561,P=0.000; rs=0.360,P=0.021),與外踝向后移位距離、后踝向上移位距離不存在相關(guān)關(guān)系(r=-0.115,P=0.473; rs=0.174,P=0.276)。以距骨傾斜角為因變量,以外踝向外移位距離、外踝短縮距離、內(nèi)踝向下移位距離、內(nèi)踝向外移位距離為自變量,最終建立的回歸方程為:距骨傾斜角=0.269+0.462×內(nèi)踝向下移位距離+0.597×外踝短縮距離-0.379×內(nèi)踝向外移位距離,內(nèi)踝向下移位距離、外踝短縮距離、內(nèi)踝向外移位距離的標(biāo)準(zhǔn)化系數(shù)分別為0.551、0.472、-0.275。結(jié)論:旋后-外旋型三踝骨折中,距骨移位與內(nèi)、外踝骨折塊移位之間均存在密切的相關(guān)性,其中內(nèi)踝骨折塊向下移位與距骨移位的相關(guān)性最強(qiáng)。臨床應(yīng)用手法復(fù)位旋后-外旋型三踝骨折時(shí),應(yīng)充分利用距骨與內(nèi)、外踝骨折塊之間緊密的筋骨結(jié)構(gòu)關(guān)系,以獲得更好的復(fù)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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備注/Memo

備注/Memo:
基金項(xiàng)目:國(guó)家自然科學(xué)基金項(xiàng)目(81273785); 2012年北京市科學(xué)技術(shù)委員會(huì)首都十大危險(xiǎn)疾病科技成果推廣項(xiàng)目(Z121100005512013)
通訊作者:成永忠 E-mail:[email protected]
更新日期/Last Update: 2016-02-29