本文選題：脛骨平臺前內(nèi)撞擊骨折 + 后外復合體損傷　； 參考：《中國運動醫(yī)學雜志》2017年11期

【摘要】：目的:明確脛骨平臺前內(nèi)側(cè)撞擊骨折在后外復合體損傷中的發(fā)生率,并分析合并脛骨平臺前內(nèi)側(cè)撞擊骨折的后外復合體損傷患者的特點。方法:回顧我科收治的后外復合體損傷患者的影像學資料,統(tǒng)計前內(nèi)側(cè)撞擊骨折的發(fā)生率。配比一組無前內(nèi)側(cè)撞擊骨折的后外復合體損傷患者為對照組,與合并前內(nèi)側(cè)撞擊骨折的后外復合體損傷患者進行比較,比較兩組患者之間后向不穩(wěn)定和內(nèi)翻不穩(wěn)定的程度;再根據(jù)骨折塊大小將前內(nèi)側(cè)撞擊骨折組分為邊緣型骨折組和壓縮型骨折組,比較兩組患者之間后向不穩(wěn)定和內(nèi)翻不穩(wěn)定的程度。結(jié)果:自2007年1月至2017年1月,我科共收治膝關節(jié)后外復合體損傷患者266例,其中,合并脛骨平臺前內(nèi)側(cè)撞擊骨折共19例,發(fā)生率為7.1%。與對照組相比,合并前內(nèi)側(cè)撞擊骨折的后外復合體損傷患者,其后向不穩(wěn)定更為嚴重(P=0.030),但兩組內(nèi)翻不穩(wěn)定并無顯著性差異(P=0.800);邊緣型骨折組和壓縮型骨折組相比,其后向不穩(wěn)定更為嚴重(P=0.026),兩組內(nèi)翻不穩(wěn)定同樣沒有顯著性差異(P=0.397)。雖然兩組之間沒有顯著性差異,但合并前內(nèi)側(cè)撞擊骨折的后外復合體損傷同時合并神經(jīng)血管損傷(乆動脈和腓總神經(jīng))的風險更大。結(jié)論:脛骨平臺前內(nèi)側(cè)撞擊骨折在后外復合體損傷中發(fā)生率為7.1%。合并脛骨平臺前內(nèi)側(cè)撞擊骨折的患者,其后向不穩(wěn)定更為嚴重;若前內(nèi)側(cè)撞擊骨折為壓縮型,其后向不穩(wěn)定也較邊緣型骨折更為嚴重。對存在壓縮型脛骨平臺前內(nèi)側(cè)撞擊骨折的病例,除需檢查后向和后外向穩(wěn)定性外,還需對血管神經(jīng)情況進行仔細評估。
[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.
【作者單位】： 北京積水潭醫(yī)院運動醫(yī)學科;
【基金】：基金項目:首都臨床特色應用研究(Z151100004015102)
【分類號】：R873
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本文編號：1747357