本文選題：踝關(guān)節(jié)骨折 + Lauge-Hansen分型��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：【目的】研究螺旋CT重建在踝關(guān)節(jié)骨折診治中的臨床價值,檢驗Lauge-Hansen分型在踝關(guān)節(jié)骨折診斷中的準確性。分析Lauge-Hansen分型適用范圍,發(fā)現(xiàn)X線漏診骨折及分型本身缺陷,探討其解決方案。【方法】回顧性分析2014年1月~2016年9月本院踝關(guān)節(jié)骨折均行X線、CT重建檢查的病例133例,男73例,女60例,平均年齡44.83歲。分別按Lauge-Hansen分型,并根據(jù)術(shù)中所見檢驗二者分型的準確性,二者間進行對比,發(fā)現(xiàn)X線漏診骨折,分析Lauge-Hansen分型本身的適用性。收集患者術(shù)前外傷史、查體、影像學(xué)資料及術(shù)中所見情況,應(yīng)用Digimizer測量軟件分析影像學(xué)圖片。踝關(guān)節(jié)正位X線片:下脛腓重疊陰影(TFO)、下脛腓間隙(TFCS)、Shenton線、硬幣征;踝穴位片:距骨內(nèi)踝間隙(MCS),距骨脛骨間隙(TCS)、距腿角、脛距角。重建CT:下脛腓間隙(TFCS)、距骨內(nèi)踝間隙(MCS)。術(shù)中:外展外旋應(yīng)力試驗、Cotton試驗、前抽屜試驗、向前應(yīng)力位X線側(cè)位片、外翻應(yīng)力位片、內(nèi)翻應(yīng)力下踝關(guān)節(jié)正位X線片、內(nèi)翻應(yīng)力試驗。結(jié)合外傷史、查體、影像學(xué)診斷標準,對每個病例均根據(jù)X線、CT重建、術(shù)中所見分別按Lauge-Hansen分型,分為X線組、CT重建組、術(shù)中組,以術(shù)中所見為標準,檢驗X線及CT分析,對比二者診斷的準確性。在這之中,發(fā)現(xiàn)X線漏診骨折,并用CT重建結(jié)果及術(shù)中所見檢驗X線Lauge-Hansen分型的可靠性。【結(jié)果】兩種影像學(xué)分型均具有較高準確性,基于X線分型的符合率為88.72%,基于CT重建分型的符合率為95.49%,二者差異具有統(tǒng)計學(xué)意義(χ2=7.1111,P0.01),其中Lauge-Hansen分型本身不適用5例,占3.75%,Lauge-Hansen分型本身適用率為96.24%,在其適用的骨折中,臨床證實分型準確率達100%。基于X線分型錯誤的有9例,不存在X線型正確而CT重建分型錯誤的情況。X線中漏診骨折的病例有7例,其中有2例通過Lauge-Hansen分型得以彌補。踝關(guān)節(jié)X線漏診的情況較多見于:韌帶損傷、高位腓骨骨折、后踝撕脫骨折、細小骨折、臨近骨折塊影響、損傷機制的初始。對于高能創(chuàng)傷、垂直暴力、直接暴力引起的踝關(guān)節(jié)骨折應(yīng)用Lauge-Hansen分型存在一定局限性。Lauge-Hansen分型的另一缺陷是沒有明確區(qū)分PAB-1型與PER-1型、PAB-2型與PER-2型,分型對此類暴力起始機制引起的踝關(guān)節(jié)損傷評定存在一定缺陷。【結(jié)論】X線、CT重建檢查結(jié)合Lauge-Hansen分型在踝關(guān)節(jié)骨折診斷中具有較高的準確性,CT重建檢查在立體直觀表現(xiàn)骨折及發(fā)現(xiàn)微小骨折方面更具優(yōu)勢,Lauge-Hansen分型本身在該類骨折中適用性較強,尤其在間接暴力引起的骨折中預(yù)測韌帶損傷、發(fā)現(xiàn)隱匿骨折等方面有較大優(yōu)勢。在踝關(guān)節(jié)骨折的診治中,X線檢查是不可或缺的,結(jié)合Lauge-Hansen分型、影像學(xué)診斷指標、查體、外傷史,能使診斷達到較高的準確率;對于行X線檢查有疑問或創(chuàng)傷較重需住院繼續(xù)治療的病例,可行CT重建檢查,三維立體而準確地展現(xiàn)踝關(guān)節(jié)損傷程度,為治療技術(shù)的方案選擇提供可靠的參考。
[Abstract]:[objective] to study the clinical value of spiral CT reconstruction in the diagnosis and treatment of ankle fracture and to test the accuracy of Lauge-Hansen classification in the diagnosis of ankle fracture.The scope of application of Lauge-Hansen classification was analyzed, and the defects of X-ray misdiagnosis fracture and classification itself were found. [methods] A retrospective analysis was made of 133 cases (73 males) who underwent X-ray CT reconstruction examination of ankle fractures from January 2014 to September 2016 in our hospital.There were 60 females with an average age of 44.83 years.According to the Lauge-Hansen classification, and according to the intraoperative results to test the accuracy of the two typing, the comparison between the two, found X-ray missed fracture, analysis of the applicability of the Lauge-Hansen classification itself.The preoperative trauma history, body examination, imaging data and intraoperative findings were collected. The imaging images were analyzed with Digimizer software.X-ray films of ankle joint: inferior tibiofibular overlap shadow: TFOO, inferior tibiofibular space TFCSC / Shenton line, coin sign; ankle acupoint film: medial malleolus space MCSA, talus tibia space TCSA, talus angle, tibiotalar angle.CTS: TFCSS of inferior tibiofibular space, MCSA of medial malleolus of talus.Intraoperative: extravasation stress test cotton test, front drawer test, forward stress position X-ray lateral film, valgus stress position film, ankle joint positive position X-ray film under varus stress, varus stress test.According to the diagnostic criteria of trauma history, physical examination and imaging, each case was reconstructed according to X-ray CT. According to the Lauge-Hansen classification, each case was divided into X ray group and CT reconstruction group, the intraoperative group was divided into two groups: X ray and CT analysis according to the standard of intraoperative findings.The accuracy of diagnosis was compared.Among them, it was found that X-ray fracture was missed, and the reliability of X-ray Lauge-Hansen classification was tested by CT reconstruction results and intraoperative findings. [results] the two imaging types had high accuracy.The coincidence rate based on X-ray classification was 88.72 and that based on CT reconstruction was 95.49. The difference between them was statistically significant (蠂 ~ 2 / 7.1111 / P0.01). Among them, Lauge-Hansen classification itself was not applicable in 5 cases, accounting for 3.75% Lauge-Hansen classification.The accuracy of clinical classification was 100%.There were 9 cases of misclassification based on X-ray classification. There were 7 cases of misdiagnosis of fracture in X-ray without correct X-ray pattern and wrong classification of CT reconstruction. Among them, 2 cases were compensated by Lauge-Hansen classification.The missed X-ray diagnosis of ankle joint was more common in ligament injury, high fibula fracture, posterior malleolus avulsion fracture, small fracture, near fracture block, and initial injury mechanism.Lauge-Hansen classification of ankle fractures caused by high energy trauma, vertical violence and direct violence has some limitations. Another defect of Lauge-Hansen classification is that there is no clear distinction between PAB-1 type and PER-1 type PAB-2 type and PER-2 type.[conclusion] X-ray CT reconstruction combined with Lauge-Hansen classification has high accuracy in the diagnosis of ankle fracture. [conclusion] X-ray CT reconstruction combined with Lauge-Hansen classification has a higher accuracy in the diagnosis of ankle fracture. [conclusion] X-ray CT reconstruction combined with Lauge-Hansen classification has a high accuracy in the diagnosis of ankle fracture. [conclusion] CT reconstruction is more accurate in the diagnosis of ankle fracture.Lauge-Hansen classification is more suitable for this kind of fractures.Especially in indirect violence in the fracture prediction ligament injury, found hidden fracture and other aspects have a greater advantage.X-ray examination is indispensable in the diagnosis and treatment of ankle fracture. Combined with Lauge-Hansen classification, imaging diagnostic index, body examination and trauma history, the diagnosis rate can reach a higher accuracy.For the patients whose X-ray examination is doubtful or whose trauma is serious, it is feasible for CT reconstruction to show the degree of ankle joint injury in three dimensional and accurate way, which provides a reliable reference for the choice of treatment technique.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R683;R816.8

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