计算机断层扫描评估Pilon骨折中腓骨肌腱移位和后内侧结构卡压情况

Computed Tomography Assessment of Peroneal Tendon Displacement and Posteromedial Structure Entrapment in Pilon Fractures.

作者信息

Fokin Alex, Huntley Samuel R, Summers Spencer H, Lawrie Charles M, Miranda Alejandro D, Caban-Martinez Alberto J, Steinlauf Steven D

机构信息

*Department of Orthopaedics, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; and †Division of Environment and Public Health, Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.

出版信息

J Orthop Trauma. 2016 Nov;30(11):627-633. doi: 10.1097/BOT.0000000000000658.

DOI:10.1097/BOT.0000000000000658

PMID:27437611

Abstract

OBJECTIVES

To determine the proportion of (1) peroneal tendon displacement (PTD) and posteromedial structure entrapment (PMSE) cases in a sample of pilon fractures, (2) missed diagnoses of PTD and PMSE on computed tomography (CT) by radiologists and attending orthopaedic trauma surgeons, and PTD and PMSE cases by (3) OTA/AO classification, and (4) fibular fracture.

DESIGN

Retrospective cohort review.

SETTING

Regional level 1 Trauma Center.

PATIENTS/PARTICIPANTS: Two hundred patients treated between July 2008 and November 2014.

INTERVENTION

Axial and reconstructed CT images were used in bone and soft tissue windows to identify PTD and PMSE.

MAIN OUTCOME MEASUREMENTS

Medical charts were reviewed to identify OTA/AO fracture classification, the presence of concomitant fibular fracture, whether radiologist CT interpretation noted PTD or PMSE, and whether attending orthopaedic trauma surgeons' operative notes mentioned recognition of and management of PTD or PMSE.

RESULTS

From the retrospective review of CT, PTD was identified in 11.0% and PMSE in 19.0% of all pilon fractures. Of the 22 patients with PTD, 59.1% sustained a concomitant fibular fracture and 90.9% sustained a 43-C fracture. Patients with PTD sustained more 43-C fractures (90.9% vs. 62.9%) but significantly fewer fibular fractures (59.1% vs. 80.3%; P = 0.023) than patients without PTD. Of the 38 patients with PMSE, 81.6% sustained a fibular fracture and 86.8% sustained a 43-C fracture. PMSE was more common in patients with 43-C fractures (86.8% vs. 61.1%). The final preoperative radiologist CT interpretation commented on PTD and PMSE in 50.0% of cases.

CONCLUSIONS

Higher energy pilon fractures (43-C) are associated with higher incidence of PMSE and PTD. Concomitant fibula fracture may play a protective role in PTD in the setting of pilon fractures. Both attending radiologists and attending orthopaedic trauma surgeons frequently fail to recognize the diagnoses of PTD and PMSE.

LEVEL OF EVIDENCE

Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

确定（1）在pilon骨折样本中腓骨肌腱移位（PTD）和后内侧结构卡压（PMSE）病例的比例；（2）放射科医生和骨科创伤主治医生在计算机断层扫描（CT）上对PTD和PMSE的漏诊情况，以及（3）按OTA/AO分类、（4）腓骨骨折划分的PTD和PMSE病例情况。

设计

回顾性队列研究。

地点

地区一级创伤中心。

患者/参与者：2008年7月至2014年11月期间接受治疗的200例患者。

干预措施

在骨窗和软组织窗中使用轴向及重建CT图像来识别PTD和PMSE。

主要观察指标

查阅病历以确定OTA/AO骨折分类、是否存在合并腓骨骨折、放射科医生的CT解读是否提及PTD或PMSE，以及骨科创伤主治医生的手术记录是否提到对PTD或PMSE的识别及处理。

结果

通过对CT的回顾性分析，在所有pilon骨折中，PTD的发生率为11.0%，PMSE为19.0%。在22例PTD患者中，59.1%合并腓骨骨折，90.9%为43-C型骨折。与无PTD的患者相比，PTD患者的43-C型骨折更多（90.9%对62.9%），但腓骨骨折明显更少（59.1%对80.3%；P = 0.023）。在38例PMSE患者中，81.6%合并腓骨骨折，86.8%为43-C型骨折。PMSE在43-C型骨折患者中更常见（86.8%对61.1%）。放射科医生术前最终的CT解读在50.0%的病例中提到了PTD和PMSE。