| 胫骨平台外侧缘撕脱骨折的特点及临床诊治分析 |
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投稿时间：2017-07-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 潘家平 |
PAN Jia-ping |
宁波市第四医院骨科, 浙江 象山 315700 |
Department of Orthopaedics, Ningbo Fourth Hospital, Xiangshan 315700, Zhejiang, China |
xspjp2012@163.com |
| 王徐灿 |
WANG Xu-can |
宁波市第四医院骨科, 浙江 象山 315700 |
Department of Orthopaedics, Ningbo Fourth Hospital, Xiangshan 315700, Zhejiang, China |
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| 黄鸣红 |
HUANG Ming-hong |
宁波市第四医院骨科, 浙江 象山 315700 |
Department of Orthopaedics, Ningbo Fourth Hospital, Xiangshan 315700, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第2期，第155-159页 |
| DOI：10.3969/j.issn.1003-0034.2018.02.012 |
| 基金项目: |
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中文摘要:
目的：探讨膝关节损伤中胫骨平台外侧缘撕脱骨折的特点及临床诊治。
方法：自2011年1月至2015年12月运用关节镜技术微创治疗关节内损伤结合双锚钉内固定胫骨平台外侧缘撕脱骨折29例，男17例，女12例；年龄27~62岁，平均41岁。20例合并前交叉韧带断裂（包含前交叉韧带胫骨止点撕脱骨折），3例合并后交叉韧带断裂，1例同时合并前交叉韧带和后交叉韧带断裂，3例合并侧副韧带撕裂，2例合并胫骨平台骨折（内侧平台骨折和外侧平台骨折各1例）。术前均行X线、CT及MRI检查明确诊断，在受伤后5~14 d进行手术，平均7 d。采用Lysholm膝关节评分对膝关节术前、术后功能进行评价。
结果：手术时间40~125 min，平均85 min；出血量10~30 ml，平均15 ml。术后所有患者获随访，时间12~18个月，平均14个月。Lysholm膝关节评分由术前的52.0±4.2明显提高至术后1年的91.9±1.4（t=-49.24，P<0.05）。抽屉试验、Lachman试验及侧方应力试验均阴性，骨折均骨性愈合。
结论：胫骨平台外侧缘撕脱骨折提示合并有膝关节静力稳定结构（关节韧带、关节囊、半月板等）的损伤，甚至关节内骨折。常规要行CT和MRI检查，建议行关节镜探查，防止漏诊，以使患者能得到及时、全面的治疗，为膝关节功能最大限度恢复创造有利条件。 |
| 【关键词】Segond骨折 前交叉韧带 后交叉韧带 侧副韧带 静力稳定结构 |
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| Analysis of the characteristics and clinical diagnosis and treatment of avulsion fracture of the lateral edge of tibial plateau |
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ABSTRACT
Objective: To investigate the characteristics and clinical treatment of avulsion fracture of the lateral edge of tibial plateau(segond fracture) in knee joint injuries.
Methods: From January 2011 and December 2015,29 patients with Segond fracture were treated with minimally invasive arthroscopy technology in intra-articular injuries combined with double anchor nail fixation in avulsion fracture of the lateral edge of tibial plateau,including 17 males and 12 females with an average age of 41 years old ranging from 27 to 62 years old. Among them,there were 20 cases of anterior cruciate ligament rupture (ACL rupture) involving the anterior cruciate ligament tibial eminence avulsion fracture included,3 cases of posterior cruciate ligament rupture (PCL rupture),1 case of ACL rupture combined with PCL rupture,3 cases of medial collateral ligament tear,and 2 cases combined fractures of tibial plateau (1 case of the medial platform fractures and 1 cases of lateral fracture). All the patients were confirmed by X-rays,CT and MRI. The procedures were performed at 5 to 14 days after the injury(means 7 days). Lysholm scores were used to assess the knee function before and after the operation.
Results: The operation time was 40 to 125 minutes (means 85 minutes),the intraoperative blood loss was 10 to 30 ml (means 15 ml). All paients were followed up for 12 to 18 months(means 14 months). The Lysholm scores were significantly improved from preoperative 52.0±4.2 to 91.9±1.4(t=-49.24,P<0.05). The results of drawer test,Lachman test and lateral stress test were negative in all 29 cases,all the fractures of 29 patients were bony union.
Conclusion: The avulsion fracture of the lateral tibial plateau suggests that there are knee joint static and stable structures(joint ligament,joint capsule,meniscus,et al) and even intra articular fractures. Therefore,besides conventional imaging examinations,arthroscopic exploration was also necessary to avoid misdiagnose and provide comprehensive assessments and treatment. This can create favorable conditions for the knee joint function restore maximum. |
| KEY WORDS Segond fracture Anterior cruciate ligament Posterior cruciate ligament Collateral ligament Static stability structure |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 潘家平,王徐灿,黄鸣红.胫骨平台外侧缘撕脱骨折的特点及临床诊治分析[J].中国骨伤,2018,31(2):155~159 |
| 英文格式: | PAN Jia-ping,WANG Xu-can,HUANG Ming-hong.Analysis of the characteristics and clinical diagnosis and treatment of avulsion fracture of the lateral edge of tibial plateau[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(2):155~159 |
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