后Plion骨折的三维骨折地图绘制与成像分析

Three-Dimensional Fracture Mapping and Imaging Analysis of Posterior Plion Fractures

摘要: 目的：本研究旨在根据CT二维与三维成像技术描绘并量化后pilon骨折线、骨折块在三平面上发生的位置和频率。方法：对我院骨科2018年1月至2020年12月收治的47例后pilon骨折的影像学资料进行回顾分析。根据CT影像学数据对骨折进行三维重建，并将骨折线、骨折块和关节面情况叠加到胫骨远端3D模型上。通过骨折线特征以及骨折块的数量和体积对骨折地图特征分别进行定性、定量总结。结果：47例后pilon骨折定位均显示后外侧与后内侧两条相交的骨折线，以及后内侧(PM)和后外侧(PL)骨块。骨折块面积与胫骨远端面积的比值(FAR1)为20.65% (4.30%~48.84%)，骨折线长度、宽度与高度的平均值分别为27.97 (14.56~45.30) mm，4.72 (0.79~21.62) mm，23.15 (9.10~42.00) mm。3D模型图显示了骨折线、粉碎区和三平面骨折块的走行分布与骨折模式。结论：后pilon骨折PM与PL骨折块较大，累及关节面的同时常累及内踝，粉碎性骨块较少。通过对三维CT模型的量化可以可靠地评估后pilon骨折的骨折特征，以此为未来内植物和生物力学模型的设计提供参考。

Abstract: Objective: This study aims to delineate and quantify the location and frequency of posterior pilon fracture lines and fracture mappings occurring in the triplane according to CT 2D and 3D imaging technology. Methods: The imaging data of 47 posterior pilon fractures admitted in our orthopedics department from January 2018 to December 2020 were reviewed. The fracture was reconstructed in 3D based on the CT imaging data, and the fracture line, fracture block, and articular surface con-ditions of distal to the tibia were superimposed on the 3D model. The fracture mapping features were qualitatively and quantitatively summarized by fracture line features and the number and volume of fracture mappings. Results: All 47 posterior pilon fracture localization showed two frac-ture lines crossing the posterolateral (PL) and posteromedial bones (PM). The average ratio of frac-ture area to distal tibia area (FAR1) was 20.65% (4.30%~48.84%), and the average value of frac-ture line length, width and height were 27.97 (14.56~45.30) mm, 4.72 (0.79~21.62) mm, and 23.15 (9.10~42.00) mm, respectively. The 3D model imaging showed the distribution and fracture pat-tern of the fracture line, comminuted area, and triplane fracture mappings. Conclusion: The PM of pilon fractures and PL fractures are large, often involving the medial malleolus and less comminut-ed bones. The fracture characteristics of posterior pilon fracture can be reliably evaluated for providing reference for the design of future implants and biomechanical models.