目的 探讨胫骨干骨折伴后踝骨折患者临床特点并构建胫骨干骨折伴后踝骨折的预测模型。方法 回顾性分析2019-01至2024-12海军第971医院骨科收治的术前接受X线片和CT检查的胫骨干骨折患者临床资料,共167例患者入选本研究,其中男108例,女59例,平均年龄(46.6±16.2)岁。根据术前CT检查结果分为合并后踝骨折组(n=63)和胫骨干骨折组(n=104)。收集患者临床及影像学资料,通过X线片和CT图像测量骨折部位、骨折长度、骨折形状的数据,使用多因素logistic回归分析胫骨干骨折合并后踝骨折的独立危险因素,并构建预测模型。采用受试者工作特征曲线(ROC)分析诊断因素的预测结果。结果 胫骨骨折位置(OR=0.913,P=0.001)、胫骨骨折长度(OR=1.154,P<0.001)和胫骨螺旋骨折(OR=10.202,P=0.002)是胫骨骨折合并后踝骨折的独立危险因素。构建预测模型为logit(P)=-0.091×胫骨骨折位置+0.143×胫骨骨折长度+2.323×胫骨螺旋骨折(是=1,否=0)-1.193。ROC曲线分析可见预测模型较单纯胫骨骨折位置、胫骨骨折长度和胫骨螺旋骨折的AUC更大。结论 基于胫骨骨折部位、胫骨骨折长度和胫骨螺旋型骨折构建的预测模型对胫骨干骨折伴后踝骨折具有较高预测价值。
Abstract
Objective To analyze the clinical features of patients with tibial shaft fractures combined with posterior malleolar fracture and to constructional model for the fractures. Methods A retrospective analysis was conducted on the clinical data of the patients with tibial shaft fractures who underwent preoperative X-ray and CT examinations at the 971th Hospital of PLA Navy from January 2019 to December 2024. A total of 167 patients were included in this study, comprising 108 males and 59 females, with a mean age of (46.6±16.2) years.The patients were divided into a combined posterior malleolar fracture group (n=63) and an isolated tibial shaft fracture group (n=104) based on the presence of posterior malleolar fracture on CT mages. Clinical and imaging data were collected. Data on fracture location, length, and morphology were measured using X-ray films and CT images. Multivariate logistic regression analysis was used to identify independent risk factors for tibial shaft fractures combined with posterior malleolar fractures, and a prediction model was constructed. The predictive results of the diagnostic factors was analyzed using the receiver operating characteristic curve (ROC). Results Tibial fracture location (OR=0.913, P=0.001), tibial fracture length (OR=1.154, P<0.001), and spiral tibial fracture (OR=10.202, P=0.002) were independent risk factors for tibial shaft fractures combined with posterior malleolar fractures. A prediction model was established, expressed as logit(P)=-0.091×tibial fracture location+0.143×tibial fracture length+2.323×spiral tibial fracture (yes=1, no=0)-1.193. The ROC curve analysis showed that the prediction model had a higher AUC than each individual factor including tibial fracture location, tibial fracture length, and spiral tibial fracture. Conclusions The prediction model constructed based on tibial fracture location, length, and spiral tibial fracture demonstrates high predictive value for tibial shaft fractures combined with posterior malleolar fractures.
关键词
胫骨干骨折 /
后踝骨折 /
X线片 /
CT /
危险因素 /
预测模型
Key words
tibial shaft fracture /
posterior malleolar fracture /
X-ray film /
CT /
risk factors /
prediction model
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Serlis A, Konstantopoulos G, Poulios P, et al. The management of posterior malleolus fractures in unstable ankle injuries:where do we stand now?[J].Cureus, 2022, 14(12):e32191.
[2] Neumann A P, Rammelt S. Ankle fractures involving the posterior malleolus:patient characteristics and 7-year results in 100 cases[J].Arch Orthop Trauma Surg, 2022, 142(8):1823-1834.
[3] 王 刚, 白晓冬, 刘振宇, 等. 胫骨干骨折合并同侧后踝骨折X线片漏诊原因分析与手术治疗策略[J]. 中国骨与关节损伤杂志, 2021, 36(4):364-367.
[4] 匡立华, 王传鑫, 李志航, 等. 胫骨干螺旋骨折并后踝骨折两种微创内固定比较[J]. 中国矫形外科杂志, 2025, 33(22):2024-2030.
[5] Lu F, Yuan Y, Zhu J, et al. Prevalence and risk factors of concomitant malleolar and fibular fractures in patients with distal spiral tibial shaft fractures[J]. Eur J Trauma Emerg Surg, 2025, 51(1):1.
[6] Bi A S, Fisher N D, Parola R, et al. Can we predict size, Haraguchi type and preoperative displacement of posterior malleolar fractures in association with tibial shaft fractures?[J]. Eur J Orthop Surg Traumatol, 2023, 33(5):1641-1651.
[7] Lisitano L, Röttinger T, Wiedl A, et al. Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures:a prospective trial[J].Eur J Trauma Emerg Surg, 2023, 49(6):2339-2345.
[8] Jung K J, Chung C Y, Park M S, et al. Concomitant ankle injuries associated with tibial shaft fractures[J]. Foot Ankle Int, 2015, 36 (10):1209-1214.
[9] 中华医学会骨科学分会足踝外科学组,中国中西医结合学会骨伤科专业委员会足踝专家工作委员会. 后踝骨折诊疗专家共识[J]. 中华骨与关节外科杂志, 2025,18(5):385-393.
[10] Lisitano L, Mayr E, Rau K, et al. Accompanying injuries in tibial shaft fractures:how often is there an additional violation of the posterior malleolus and which factors are predictive? A retrospective cohort study[J]. Eur J Trauma Emerg Surg, 2022, 48 (4):3171-3176.
[11] Myatt D, Stringer H, Chapman J, et al. Prediction of distal tibial articular extension in tibial shaft fractures:both posterior malleolar fracture and non posterior malleolar fracture intra-articular extension[J]. Eur J Trauma Emerg Surg, 2023, 49 (2):903-910.
[12] Wang Z, Tan Z, Wang Y, et al. Incidence and risk factors of occult posterior malleolar fracture in patients with spiral distal tibial fracture:reexamination and analysis[J]. Asian J Surg, 2022, 45 (7):1389-1395.
[13] 李勇奇, 黄 辉, 李 兵, 等. 成人后踝骨折临床特征分析[J]. 中华医学杂志, 2024,104(3):212-217.
[14] 凌中华,冯金柱. 胫骨干骨折合并隐匿性后踝骨折情况及危险因素[J]. 中国中医骨伤科杂志, 2024, 32(5):41-45,49.
[15] 盛 凯, 王鹏程,任 栋, 等. 胫骨远端后侧解剖学特征的测量与分析[J]. 解剖学杂志, 2025, 48(6):464-470.
[16] 袁明远. 足踝部漏诊、误诊骨折的影像诊断[J]. 中国临床医师杂志, 2023, 51(5):528-532.
[17] Fernández R E, Herrera P M, Vilá R J. Posterior malleolar fractures:indications and surgical approaches[J]. Rev Esp Cir Ortop Traumatol, 2023, 67 (2):160-169.
[18] 杨 涛, 朱凤华, 李恒艳, 等. 胫骨远段螺旋形骨折伴踝关节损伤的研究[J]. 中华创伤骨科杂志, 2023, 25(7):576-583.
[19] Mitchell P M, Harms K A, Lee A K, et al. Morphology of the posterior malleolar fracture associated with a spiral distal tibia fracture[J]. J Orthop Trauma, 2019, 33(4):185-188.
[20] 李晓亮, 孙培锋, 刘红国, 等.不同类型Maisonneuve骨折的影像解剖学特征和损伤机制[J].武警医学, 2024, 35(12):1024-1027.
[21] Wang C, Chen C, Zhou Y, et al. Morphological study of CT image of posterior pilon variant fracture and its possible clinical significance[J]. Arch Orthop Trauma Surg, 2023,143(3):1203-1215.
[22] Koca H, Duman S, Sağlam N. Radiographic and clinical outcomes of distal tibia fractures (3-12 cm proximal to the plafond):comparison of two intramedullary nailing[J]. Ulus Travma Acil Cerrahi Derg, 2022, 28 (5):686-692.
[23] 廖 维, 王 广, 张有强, 等. 张-侯氏骨折的影响因素分析[J]. 中国医药导报,2022, 19 (27):80-83.
[24] 李厚举, 孙传涛. 后 Pilon 骨折的诊断与治疗研究进展[J]. 中国骨与关节损伤杂志,2022, 37 (4):446-448.
[25] Myatt D, Stringer H, Chapman J, et al. Morphology of occult posterior malleolus fractures associated with tibial shaft fractures[J]. Bone Joint Open, 2025,6(4):446-453.
基金
青岛市卫健委医药科研指导计划项目(2020-wjzd191)
PDF(1291 KB)
