CAJ | 학술논문

目的通过CT三维重建分析外踝骨折后三角韧带完整性对踝关节稳定性的影响.方法选用18具成年人下肢标本,男11具,女7具；年龄55～79岁,平均68.2岁；均排除下肢外伤病史.将18具标本平均分为两组,每组9具.1组只切断下胫腓前韧带,即三角韧带完整组；2组同时切断下胫腓前韧带和内踝三角韧带,即三角韧带损伤组.每具标本于外踝尖近端3 cm处横行截断腓骨,通过标记的克氏针分别建立远端腓骨外旋5°、10°、15°、30°的畸形模型,并行钢板螺钉固定.每次建模后均行薄层CT扫描.将所有CT数据导入Mimics 10.01软件,通过自动密度识别及后期人工处理描绘下胫腓联合、踝穴及踝穴内距骨轮廓,运用软件建立下胫腓联合、踝穴、踝穴内距骨三维模型,并自动计算各模型体积.通过踝穴及踝穴内距骨体积相减,得到踝关节间隙体积.比较组间及组内不同旋转度数时各模型体积的变化,从而反映各病理模型对踝关节稳定性的影响.结果随着旋转畸形度数增加,下胫腓联合及踝穴体积增大,而踝穴内距骨体积随之减小.在三角韧带完整组中不同旋转角度所致畸形模型比较,10°旋转畸形时下胫腓联合体积及踝关节间隙较正常开始出现显著性增大.在三角韧带损伤组中不同旋转角度所致畸形模型比较,5°旋转畸形即开始出现踝关节间隙及下胫腓体积较正常时显著性增大.结论三角韧带完整性可影响外旋畸形时踩关节间隙的变化.当三角韧带完整时,10°外踝旋转畸形即可导致下胫腓联合及踝关节间隙显著性增大；而当合并三角韧带损伤时,5°旋转畸形即可出现踝关节间隙显著性增大,下胫腓联合显著性分离,踝关节不稳定.
목적 통과CT삼유중건분석외과골절후삼각인대완정성대과관절은정성적영향.방법 선용18구성년인하지표본,남11구,녀7구；년령55～79세,평균68.2세；균배제하지외상병사.장18구표본평균분위량조,매조9구.1조지절단하경비전인대,즉삼각인대완정조；2조동시절단하경비전인대화내과삼각인대,즉삼각인대손상조.매구표본우외과첨근단3 cm처횡행절단비골,통과표기적극씨침분별건립원단비골외선5°、10°、15°、30°적기형모형,병행강판라정고정.매차건모후균행박층CT소묘.장소유CT수거도입Mimics 10.01연건,통과자동밀도식별급후기인공처리묘회하경비연합、과혈급과혈내거골륜곽,운용연건건립하경비연합、과혈、과혈내거골삼유모형,병자동계산각모형체적.통과과혈급과혈내거골체적상감,득도과관절간극체적.비교조간급조내불동선전도수시각모형체적적변화,종이반영각병리모형대과관절은정성적영향.결과 수착선전기형도수증가,하경비연합급과혈체적증대,이과혈내거골체적수지감소.재삼각인대완정조중불동선전각도소치기형모형비교,10°선전기형시하경비연합체적급과관절간극교정상개시출현현저성증대.재삼각인대손상조중불동선전각도소치기형모형비교,5°선전기형즉개시출현과관절간극급하경비체적교정상시현저성증대.결론 삼각인대완정성가영향외선기형시채관절간극적변화.당삼각인대완정시,10°외과선전기형즉가도치하경비연합급과관절간극현저성증대；이당합병삼각인대손상시,5°선전기형즉가출현과관절간극현저성증대,하경비연합현저성분리,과관절불은정.
Objective To evaluate the ankle stability on lateral malleolar rotational models based on three-dimensonal CT reconstruction and volume rendering technique.Methods Eighteen cadaveric specimens were utilized in the study (male 11;female 7; 68.2 years in average) and were divided into 2 groups in which the first group only cut the anterior tibiofibular ligament and defined as intact deltoid ligament group.Another group additionally cut the deltoid ligament and defined as deltoid ligament injured group.Fibular transverse osteotomy was performed at 3 cm proximal to the ankle joint and lateral malleolar rotational malunion model of 5°,10°,15° and 30° were built in every specimen.CT scanning was performed for each model then and all CT data were imported into Mimics 10.01 software.The structures of distal syndesmosis,ankle mortise as well as talus in the mortise were outlined by automatic dense identifying and manually modified later.Three-Dimensional models of these structures and their volume were outputted in the software.The volume of ankle clear space was calculated as the difference value of ankle mortise and talus in the mortise.Ankle stability was reflected by comparison of these volumes to the normal condition.Results With the rising of malrotational degree,the volume of inferior syndesmosis and mortise were increased and the volume of talus in the mortise was reduced.In the deltoid ligament intact group,10° of malrotation would significantly enlarged the volume of distal syndesmosis and ankle clear space when compared to normal condition.However,in the deltoid ligament injured group,5° of rotational deformity would significantly enlarge the volume of ankle clear space and distal syndesmosis.Conclusion The condition of deltoid ligament has significant impact on ankle stability in cases of lateral malrotional deformity.Distal syndesmosis and ankle clear space were significantly enlarged at 10° malrotation deformity.However,additional deltoid ligament injury can significantly reduce ankle stability at just 5° of distal fibular rotational deformity.