中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (9): 2248-2254.doi: 10.12307/2025.984

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

青少年胫骨远端三平面骨折的骨折地图绘制与成像分析

王泊凯1,2,王志强1,周宏艳2,李骏然2,武一恒1,2,赵洪波2   

  1. 1华北理工大学附属医院,河北省唐山市  063000;2唐山市第二医院,河北省唐山市  063000
  • 收稿日期:2024-09-21 接受日期:2024-12-14 出版日期:2026-03-28 发布日期:2025-09-06
  • 通讯作者: 赵洪波,博士,主任医师,唐山市第二医院,河北省唐山市 063000
  • 作者简介:王泊凯,男,1997年生,河北省唐山市人,汉族,2021年河北工程大学毕业,医师,主要从事运动医学、小儿骨科方面的研究。
  • 基金资助:

Fracture mapping and imaging analysis of triplane fracture of distal tibia in adolescents

Wang Bokai1, 2, Wang Zhiqiang1, Zhou Hongyan2, Li Junran2, Wu Yiheng1, 2, Zhao Hongbo2   

  1. 1Affiliated Hospital of North China University of Technology, Tangshan 063000, Hebei Province, China; 2Tangshan Second Hospital, Tangshan 063000, Hebei Province, China 
  • Received:2024-09-21 Accepted:2024-12-14 Online:2026-03-28 Published:2025-09-06
  • Contact: Zhao Hongbo, MD, Chief physician, Tangshan Second Hospital, Tangshan 063000, Hebei Province, China
  • About author:Wang Bokai, Physician, Affiliated Hospital of North China University of Technology, Tangshan 063000, Hebei Province, China; Tangshan Second Hospital, Tangshan 063000, Hebei Province, China

摘要:

文题释义:

胫骨远端三平面骨折:三平面骨折,即骨折同时发生在水平面、矢状面和冠状面的一种特殊类型骨折。胫骨远端三平面骨折是青少年特有的一种累及骨骺板的复杂踝关节损伤,发病率占骨骺损伤的6%-10%,占踝部骨骺分离骨折的17%,由于其只发生于胫骨远端骺板闭合期的青少年,因此在临床相对少见。
骨折地图:又称为“骨折线分布图”“骨折地形图”,由ARMITAGE等于2009年在国际上首次提出,该技术是在CT原始资料中提取骨折模型,通过旋转、平移等操作将骨折模型复位,然后通过对齐特定解剖标志将多个病例叠加在一个标准的骨骼模型上以生成骨折地图。目前国内外相关研究已有百余篇,此次研究是目前已知的国内首个将骨折地图技术应用于胫骨远端三平面骨折的研究。

摘要
背景:胫骨远端三平面骨折只发生于骨骺闭合期的青少年,由于其复杂且独特的空间结构,在治疗时十分考验临床医生的经验与理解。近年来骨折地图绘制技术发展迅速,已广泛应用于各部位骨折。
目的:通过骨折地图技术绘制青少年胫骨远端三平面骨折地图,观察横断面骨折线的形态、位置及分布频率,分析胫骨远端三平面骨折特征。
方法:回顾性研究79例胫骨远端三平面骨折患者的病历资料,收集其原始CT资料,通过Mimics 21.0软件获取所需的两个横断面图像,在Photoshop 24.0软件中将患者CT图像复位并拟合到标准模板,描绘并叠加全部骨折线生成骨折地图,然后使用Matlab(r2023b)软件创建热图以显示高密度和低密度骨折区域,分析骨折线分布规律。
结果与结论:①纳入的79例青少年患者中男性占73%,女性占27%;年龄10-15岁,平均(12.8±1.5)岁;②干骺端的骨折线主要集中于后侧;关节面的骨折线则呈现出明显的“Y”型特征,此平面的骨折线又可细分为“Y”字型(18%)、横型(32%)、前内侧切迹型(33%)及其他型(17%);分区骨折地图显示不同区域通过的骨折线数量存在显著差异(P < 0.01);③关节面层面“Y”字型特征骨折线的形成可能与下胫腓前、后韧带有关。结果表明,骨折地图可为胫骨远端三平面骨折提供一个直观的视觉框架,并为进一步的影像学分型、内固定物设计、螺钉放置方式等方面提供参考。


中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 三平面骨折, 胫骨, 青少年, CT, 骨折线, 骨折地图, 骨折热图

Abstract: BACKGROUND: Because of its complex and unique spatial structure, the triplane fracture of the distal tibia only occurs in adolescents with epiphyseal closure, which is a great test for clinicians’ experience and understanding in the treatment. In recent years, fracture mapping technology has developed rapidly and has been widely used in trauma orthopedics. 
OBJECTIVE: To draw a triplane fracture map of the distal tibia in adolescents by using fracture mapping technology, observe the shape, location, and frequency of the cross-sectional fracture line, and analyze the characteristics of the triplane fracture of the distal tibia. 
METHODS: The medical records of 79 patients with triplane fractures of the distal tibia were retrospectively studied. The original CT image data were collected. The required two cross-sectional images were obtained by Mimics 21.0 software. The patient’s CT images were reset and fitted to the standard template in Photoshop 24.0 software, and all fracture lines were depicted and superimposed to generate a fracture map. The Matlab (r2023b) software was used to create a heat map to show the high-density and low-density fracture areas, and the distribution of fracture lines was analyzed.
RESULTS AND CONCLUSION: (1) Among the 79 adolescent patients included in this study, 73% were male and 27% were female, with an average age of 12.8±1.5 years (range, 10-15 years). (2) The fracture line of metaphysis mainly concentrated in the posterior side. The fracture line of the articular surface showed obvious “Y” type characteristics. The fracture line of this plane could be subdivided into “Y” type (18%), transverse type (32%), anteromedial notch type (33%) and other types (17%). The zonal fracture map showed that there were significant differences in the number of fracture lines passing through different regions (P < 0.01). (3) The formation of the “Y” shaped fracture line on the articular surface may be related to the anterior and posterior ligaments of the lower tibiofibula. The results show that the fracture map can provide an intuitive visual framework for the triplane fracture of the distal tibia, and provide references for further image classification, internal fixation design, and screw placement.


Key words: triplane fracture, tibia, adolescent, CT, fracture line, fracture map, fracture heat map

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