胫骨平台前内侧撞击骨折在膝关节后外复合体损伤中的意义

发布时间：2018-04-14 02:34

  本文选题：胫骨平台前内撞击骨折 + 后外复合体损伤　； 参考：《中国运动医学杂志》2017年11期

【摘要】：目的:明确胫骨平台前内侧撞击骨折在后外复合体损伤中的发生率,并分析合并胫骨平台前内侧撞击骨折的后外复合体损伤患者的特点。方法:回顾我科收治的后外复合体损伤患者的影像学资料,统计前内侧撞击骨折的发生率。配比一组无前内侧撞击骨折的后外复合体损伤患者为对照组,与合并前内侧撞击骨折的后外复合体损伤患者进行比较,比较两组患者之间后向不稳定和内翻不稳定的程度;再根据骨折块大小将前内侧撞击骨折组分为边缘型骨折组和压缩型骨折组,比较两组患者之间后向不稳定和内翻不稳定的程度。结果:自2007年1月至2017年1月,我科共收治膝关节后外复合体损伤患者266例,其中,合并胫骨平台前内侧撞击骨折共19例,发生率为7.1%。与对照组相比,合并前内侧撞击骨折的后外复合体损伤患者,其后向不稳定更为严重(P=0.030),但两组内翻不稳定并无显著性差异(P=0.800);边缘型骨折组和压缩型骨折组相比,其后向不稳定更为严重(P=0.026),两组内翻不稳定同样没有显著性差异(P=0.397)。虽然两组之间没有显著性差异,但合并前内侧撞击骨折的后外复合体损伤同时合并神经血管损伤(乆动脉和腓总神经)的风险更大。结论:胫骨平台前内侧撞击骨折在后外复合体损伤中发生率为7.1%。合并胫骨平台前内侧撞击骨折的患者,其后向不稳定更为严重;若前内侧撞击骨折为压缩型,其后向不稳定也较边缘型骨折更为严重。对存在压缩型胫骨平台前内侧撞击骨折的病例,除需检查后向和后外向稳定性外,还需对血管神经情况进行仔细评估。
[Abstract]:Objective: to investigate the incidence of anterior medial impact fracture of tibial plateau in posterior external complex injury and to analyze the characteristics of posterior external complex injury complicated with anterior medial tibial plateau impingement fracture.Methods: the imaging data of patients with posterior complex injury were reviewed and the incidence of anterior medial impingement fracture was analyzed.A group of patients with posterior external complex injury without anterior medial impact fracture as control group was compared with patients with posterior external complex injury associated with anterior medial impact fracture to compare the degree of backward instability and varus instability between the two groups.According to the size of the fracture block, the anterior medial impact fracture group was divided into marginal fracture group and compression fracture group, and the degree of backward instability and varus instability were compared between the two groups.Results: from January 2007 to January 2017, 266 cases of posterior complex injury of knee joint were treated in our department. Among them, 19 cases were complicated with anterior medial impact fracture of tibial plateau, the incidence rate was 7.1.Compared with the control group, the patients with posterior external complex injury complicated with anterior medial impact fracture had more severe backward instability (P 0.030), but there was no significant difference between the two groups in varus instability (P < 0. 800), and there was no significant difference between the marginal fracture group and the compression type fracture group.There was no significant difference between the two groups in varus instability (P < 0. 397).Although there was no significant difference between the two groups, the risk of injury of the posterior external complex combined with anterior medial impingement fracture was higher than that of the nerve and vascular injury (the common peroneal nerve and the artery).Conclusion: the incidence of anterior medial impact fracture of tibial plateau in posterior external complex injury is 7.1.If the anterior medial impact fracture of tibial plateau is compressed, the posterior instability is more serious than that of marginal fracture.In the case of compressed anterior medial impact fracture of tibial plateau, it is necessary to evaluate the vascularity and nerve status in addition to the retrograde and retro-outward stability.
【作者单位】： 北京积水潭医院运动医学科;
【基金】：基金项目:首都临床特色应用研究(Z151100004015102)
【分类号】：R873
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本文编号：1747357