目的:距骨是踝关节的重要组成部分,受伤后的治疗至关重要。然而,由于不完整的传统分类导致的并发症和不良事件仍然可能发生,这些分类未能从三维角度分析裂缝的模式和分布。因此,在这项研究中,我们旨在使用三维(3D)和热图技术分析不同类型距骨骨折中骨折线的位置和分布。此外,我们旨在确定可用于不同内固定方法的距骨表面积,帮助规划外科手术。
方法:我们回顾性分析了在我们两家医院诊断为距骨骨折的126例患者的CT扫描数据。我们提取了健康成年人的CT数据,并创建了标准的距骨模型。我们使用患者的CT图像进行了3D重建,并将骨折模型叠加到标准模型上,以绘制骨折线。随后,我们将断裂线转换成热图进行可视化。此外,我们测量了20个标本,以确定附着在距骨上的各种韧带的边界。我们通过将边界数据与先前报道的暴露面积数据相结合,确定了可用于不同手术方法的距骨表面积。
结果:在不考虑骨折的位移距离的情况下,骨折类型分类如下,结合Hawkins和Sneppen分类:距骨颈,41.3%;距骨后结节,22.2%;身体为距骨和粉碎,17.5%;距骨外侧结节,11.9%;距骨头,7.1%。我们使用这种分类建立了裂缝线和热图。此外,我们展示了前内侧的可用区域,前外侧,后内侧,后外侧,内踝截骨术和Chaput截骨术。
结论:骨折线和热图分析可以帮助外科医生为距骨骨折的复位和内固定规划单一或联合手术方法。演示不同的手术方法可以帮助外科医生为个别情况选择最有效的技术。
OBJECTIVE: The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures.
METHODS: We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients\' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure.
RESULTS: Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches.
CONCLUSIONS: Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.