目的 探讨多层螺旋CT(MSCT)对 后踝、后pilon骨折的鉴别诊断价值。 方法 回顾性分析2015年1月-2017年5 月收治的100例胫骨远端后侧骨折(包括 后踝骨折38例、后pilon骨折62例)患者 CT影像学资料。结果 后踝骨折β角、 FAR1、FAR2分别为（74.28±12.00)°、 (6.81±3.29)%、(15.08±5.13)%，比 后plion骨折的(79.42±10.83）°、 (23.79±12.34)%、(28.27±10.64)%均 显著低(P＜0.05)；I型后踝骨折FAR1、 FAR2均显著大于II型(P＜0.05)；II型、 III型FAR1均显著大于I型(P＜0.05)，而 II型、III型间比较差异无统计学意义(P ＞0.05)；不同分型后plion骨折FAR2比较 差异无统计学意义(P＞0.05)。结论 后 plion骨折相比后踝骨折矢状面上与地面 垂直相关度更大，横切面、矢状面面积 均显著大，且踝关节脱位发生风险显著 大。

Objective To investigate the value of multi-slice spiral CT (MSCT) in the differential diagnosis of posterior malleolus and posterior Pilon fractures. Methods CT imaging data of 100 cases of patients with distal posterior tibial fractures (including 38 cases of posterior malleolus fractures and 62 cases of posterior Pilon fractures) who were treated from January 2015 to May 2017 were retrospectively analyzed. Results The β angle, FAR1 and FAR2 of posterior malleolus fractures were significantly smaller or lower than those of Pilon fractures [(74.28±12.00) degrees, (6.81±3.29) %, (15.08±5.13)% vs (79.42±10.83) degrees, (23.79±12.34)%, (28.27±10.64)%] (P<0.05). The FAR1 and FAR2 of type I posterior malleolus fractures were significantly higher than those of type II (P<0.05). FAR1 of type II and type III were significantly larger than that of type I (P<0.05), but there was no significant difference between type II and type III (P>0.05). There was no significant difference in FAR2 between different types of posterior Pilon fractures (P>0.05). Conclusion Compared with the posterior malleolus fractures, the vertical correlation between sagittal plane and ground surface of posterior Pilon fractures is more obvious, the transverse and sagittal areas are significantly larger, and the risk of ankle joint dislocation is significantly higher.