1、浙江创伤外科2023年4月第28卷第4期Zhejiang J Trauma Surg,April 2023,Vol.28,No.4作者单位：313100长兴，浙江省长兴县中医院（朱国萍，沈庆峰，薛必永）；浙江大学医学院附属邵逸夫医院（寿蓓丽）踝关节骨折作为临床上较为常见的关节内骨折，以足踝部疼痛、畸形、肿胀及皮下淤血为主要临床表现1。其诱因多为交通伤、运动伤、坠落和跌倒扭伤等直接或间接暴力易导致踝关节出现不同分型的骨折2。同时，踝关节骨折因其特殊的解剖结构需明确诊断骨折分型，不仅是制定治疗方案的前CT 三维重建在老年踝关节骨折 Lauge-Hansen 分型及术后效果评估中的价值研究朱国萍寿蓓
2、丽沈庆峰薛必永【摘要】目的探讨在老年踝关节骨折Lauge-Hansen分型及其术后效果评估中CT三维重建的应用价值研究。方法选取2020年3月至2022年3月收治的68例老年踝关节骨折患者作为研究对象。所有患者治疗前均进行X射线及CT检查，以术中探查诊断结果为“金标准”。比较两种检查方式在老年踝关节骨折Lauge-Hansen分型中的诊断准确率；两种检查方式在不同分型中的解剖复位质量及内固定置入质量情况；治疗前后踝关节功能及炎症因子IL-1水平变化，并通过Logistics多因素回归分析影响老年踝关节功能恢复的相关因素。结果以术中探查诊断结果为“金标准”，CT三维重建在老年踝关节骨折Lauge
3、-Hansen分型中的诊断准确率为94.12%（64/68）显著高于X射线的76.47%（52/68），存在统计学差异（P0.05）。术后效果评估通过观察解剖复位质量及内固定置入质量的检出率，CT三维重建在旋前外旋型（PER）、旋前外展型（PAB）、旋后外旋型（SER）、旋后内收型（SAB）的检出率均显著高于X射线，其中两种检查方式在PER型、PAB型、SER型3种分型比较上存在统计学差异（P0.05）。术后踝关节功能恢复方面，治疗后的踝关节AOFAS评分及炎症因子IL-1水平较治疗前比较均明显改善（P0.05），Logistics多因素回归分析结果显示Lauge-Hansen分型、术后的解剖
4、复位质量及内固定置入质量情况是老年踝关节骨折患者术后踝关节功能恢复的影响因素。结论CT三维重建在老年踝关节骨折Lauge-Hansen分型、术后解剖复位质量及内固定置入质量中具有较高的诊断准确率，同时，Lauge-Hansen分型、术后解剖复位质量及内固定置入质量情况是老年踝关节骨折患者术后踝关节功能恢复的影响因素。【关键词】CT三维重建；老年；踝关节骨折；Lauge-Hansen分型；术后评估【中图分类号】R687.3【文献标识码】Adoi：10.3969/j.issn.1009-7147.2023.04.002The value of CT three-dimensional recons
5、truction in the assessment of Lauge-Hansen staging and postoperative outcome of ankle frac-tures in the elderlyZHU Guoping,SHOU Beili,SHEN Qingfeng,et al.Changxing County Hospital of Traditional Chinese Medicine,Zhejiang 313100,China.【Abstract】ObjectiveTo investigate the value of CT 3D reconstructio
6、n in the application of the Lauge-Hansen staging of ankle fractures inthe elderly and their postoperative outcome assessment.Methods68 elderly patients with ankle fractures admitted from March 2020 to March2022 were selected for the study.All patients underwent X-ray and CT examinations prior to tre
7、atment,and intraoperative investigation was used asthe“gold standard”for diagnosis.The diagnostic accuracy of the two examination methods was compared in terms of the accuracy of the diagnosis ofankle fractures in elderly patients with the Lauge-Hansen classification.The quality of anatomical reposi
8、tioning and the quality of internal fixationplacement in the different classifications.The changes in ankle function and the level of the inflammatory factor IL-1 before and after treatment,andthe factors affecting the recovery of ankle function in elderly patients were analyzed by logistic multifac
9、torial regression.ResultsUsing the intraop-erative findings as the gold standard,the diagnostic accuracy of CT 3D reconstruction in the diagnosis of ankle fractures in the elderly was 94.12%（64/68 cases）compared to 76.47%(52/68 cases)for X-ray,a statistically significant difference(P0.05).There was
10、a statistical difference(P0.05).Interms of postoperative outcome assessment,the detection rate of anatomical repositioning quality and internal fixation placement quality was signifi-cantly higher in CT 3D reconstruction than in X-ray for PER,PAB,SER and SAB types,with a statistical difference betwe
11、en the two examinationmethods for the three types of PER,PAB and SER types(P0.05).In terms of postoperative ankle function recovery,the postoperative ankle AOFASscore and inflammatory factor IL-1 levels were significantly improved compared to the preoperative levels(P0.05).The results of the logisti
12、c multi-ple regression analysis showed that Lauge-Hansen staging,quality of postoperative anatomical repositioning and quality of internal fixation placementwere factors influencing postoperative ankle function recovery in elderly patients with fractures.ConclusionCT three-dimensional reconstruction
13、has a high diagnostic accuracy rate in the Lauge-Hansen staging of elderly ankle fractures,the quality of postoperative anatomical repositioning andthe quality of internal fixation placement,while the condition of the Lauge-Hansen staging,the quality of postoperative anatomical repositioning andthe
14、quality of internal fixation placement are factors influencing the recovery of postoperative ankle function in elderly ankle fracture patients.【Key words】CT 3D reconstruction;Elderly;Ankle fracture;Lauge-Hansen staging;Postoperative evaluation 临床研究 612浙江创伤外科2023年4月第28卷第4期Zhejiang J Trauma Surg,April
15、 2023,Vol.28,No.4提，而且是有效改善预后的基础3。X射线和CT是目前临床上应用于踝关节骨折的主要诊断技术，尤其是随着多排螺旋CT的出现，其三维成像构建技术使得踝关节骨折诊断更加全面、精准4。目前，临床上的研究多集中于青中年人群，反而老年人群关注及研究较少。故本研究选取2020年3月至2022年3月收治的68例老年踝关节骨折患者，分析CT三维重建在老年踝关节骨折Lauge-Hansen分型及其术后效果评估中的应用价值。1资料与方法1.1一般资料选取2020年3月至2022年3月收治的68例老年踝关节骨折患者作为研究对象。符合以下纳入标准：所有患者经临床症状、实验室及影像学检查诊断
16、为踝关节骨折；年龄60岁，且为单侧闭合性骨折；未进行相关治疗；自愿参加且无精神类疾病。排除标准：伴有严重内、外科疾病或踝骨先天性畸形、病理性骨折、开放性骨折等；既往伴有踝关节骨折或手术史；中途退出或影像资料不完整。所有患者治疗前均进行X射线及CT三维重建检查，以术中探查诊断结果为“金标准”。68例患者年龄介于6182岁，（73.717.52）岁；性别（男/女：38/32）；体 重 指 数BMI介 于15.4235.63 kg/m2，（23.352.73）kg/m2；损伤机制（交通伤/扭伤/高空坠伤/其他：31/24/11/2）；损伤肢体（左侧/右侧：32/36）。本研究遵循医院医学伦理学的相关要求，纳入的患者对治疗方案均知情同意。1.2检查方法纳入68例老年踝关节骨折患者影像学资料均由同一组2名高年资影像科医师进行双盲法完成。手术治疗由本院骨科同一位主任医师完成。所有患者入院治疗均完成X射线及CT三维重建检查。X射线检查：应用本院DR机，参数设置（电流500 mA、电压63 kV）完成后，老年踝关节骨折患者在医师指导下端坐，将患肢放置于摄影床上进行常规X射线正位片；患者按指导取侧卧位，
