踝关节Logsplitter损伤的影像学特征与损伤机制的研究

目的总结高能量踝关节骨折Logsplitter损伤的影像学表现及踝关节周围各解剖结构的损伤特征,探讨Logsplitter损伤的发生机制。方法回顾性分析2009年4月—2018年12月西安交通大学附属红会医院足踝外科62例Logsplitter损伤患者的影像资料。其中男44例、女18例,年龄21~69(42.3±11.7)岁,左侧27例、右侧35例。提取术前X线和CT影像,分析腓骨损伤、胫骨损伤、下胫腓联合损伤、踝关节内侧损伤及外侧韧带损伤的特征及其不同损伤类型在本组Logsplitter损伤中的占比;结合踝关节骨折的Lauge-Hansen分型,分析不同踝关节骨折类型在本组Logsplitter损伤中的占比。结果腓骨损伤特征:横行或短斜形骨折占61.3%(38/62),存在蝶形骨块占25.8%(16/62),粉碎性骨折占11.3%(7/62),腓骨无骨折占1.6%(1/62)。胫骨损伤特征:外侧关节面压缩占38.7%(24/62),合并后侧压缩占6.5%(4/62);内侧损伤包括内踝骨折占87.1%(54/62),三角韧带断裂占12.9%(8/62)。下胫腓联合损伤特征:单纯韧带断裂占11.3%(7/62),合并Tillux结节撕脱骨折占8.1%(5/62),合并Volkmann结节撕脱骨折占43.5%(27/62),同时合并Tillux结节与Volkmann结节撕脱骨折占37.1%(23/62);合并踝关节外侧副韧带完全断裂占12.9%(8/62)。根据Lauge-Hansen分型显示,其中旋前外展损伤占87.1%(54/62),旋前外旋损伤占8.1%(5/62),旋后外旋损伤占1.6%(1/62),无法分类的占3.2%(2/62)。结论Logsplitter损伤的影像学特征多样化,在严重骨折脱位的同时,可合并侧副韧带损伤;损伤机制以外展位垂直暴力最为多见,部分也可为外旋位垂直暴力所致。

Radiological characteristics and injury mechanism of ankle joint Logsplitter injury

Objective To evaluate the radiological features of the Logsplitter injury in high energy ankle fractures and the pathological features of the anatomical structures around the ankle joint. To explore the mechanism of Logsplitter injury.Methods Retrospective analysis of 62 cases of Logsplitter lesions admitted to the Red Cross Hospital affiliated to Xi'an Jiaotong University from April 2009 to December 2018. There were 44 males and 18 females, aged 21-69 (42.3±11.7) years, 27 cases on the left side and 35 cases on the right side. The characteristics of fibula injury, tibia injury, syndesmosis injury, medial injury and lateral ligament injury in the preoperative X-ray and CT scans were analyzed. The incidence of different injury types was summarized. According to the Lauge-Hansen classification of ankle fractures, the correlation between Logsplitter injuries and different types of mechanicals were analyzed.Results The fibula injuries without fracture (1.6%, 1/62), transverse or short oblique fractures (61.3%, 38/62), and butterfly fragments (25.8%, 16/62) and comminuted fractures (11.3%, 7/62). The tibial injuries included compression of lateral articular surfaces (38.7%, 24/62) and posterior compressions (6.5%, 4/62). Medial injuries including medial malleolus fractures accounted for 87.1%(54/62), deltoid ligament rupture accounted for 12.9%(8/62). The injuries of syndesmosis included simple ligament ruptures (11.3%, 7/62), combined with Tillux fractures (8.1%, 5/62), combined with Volkmann fractures (43.5%, 27/62), combined with Tillux and Volkmann fractures (37.1%, 23/62). Complete rupture of lateral collateral ligament was found in 12.9%(8/62) cases. According to Lauge-Hansen classification, 87.1%(54/62) were pronation-abduction injuries. And 8.1%(5/62) were pronation and external rotation injuries. And 1.6%(1/62) was supination external rotation injuries. And 3.2%(2/62) could not be classified.Conclusions The pathoanatomic features of Logsplitter injury are diversified. In the case of severe fracture and dislocation, the collateral ligament injury can be combined. The vertical violence is the most common injury mechanism, however, in some cases; the mechanism may be the vertical combined external-rotation injury.