摘要
目的提出难复性胫骨干骨折的概念,并探讨其影像学特点与临床意义。方法回顾性分析2013年11月至2018年6月安徽医科大学第二附属医院创伤骨科术中需有限切开复位髓内钉固定治疗的21例胫骨干骨折患者资料。男14例,女7例;年龄2l^66岁,平均34.9岁;左侧15例,右侧6例。所有患者均首先闭合复位,通过牵引折叠旋转等手法,反复多次不能顺利复位、插入导针,改为局部有限切开复位髓内钉固定治疗。收集患者的X线片和CT资料并分析其骨折的影像学特点,归纳难复位性胫骨干骨折的影像学表现形式有4种:单一节段胫骨型,即胫骨干单一节段骨折,腓骨完整;多段型,即胫骨骨折为多段;交锁型,常见于短螺旋形及短斜形骨折,远、近骨折端形成交锁;嵌顿型,即骨折间隙有骨块的阻挡。末次随访时采用美国特种外科医院(HSS)膝关节评分和Kofoed评分标准踝关节评分评定疗效。结果21例患者中,单一节段胫骨型2例,多段型4例,交锁型13例,嵌顿型2例。21例患者术后获7~50个月(平均22.7个月)随访。骨折愈合时间为5~16个月(平均7.3个月)。术后膝前疼痛3例,骨折延迟愈合2例。无一例患者发生骨髓炎、浅表伤口感染、内固定断裂或骨折畸形愈合。末次随访时HSS膝关节评分和Kofoed踝关节评分评定疗效:优15例,良4例,可2例,优良率达90.5%。结论本研究提出的难复性胫骨干骨折概念可在术前提示避免反复多次复位、减少局部骨折断端血供破坏及手术时间。
Objective To propose a concept of irreducible tibial shaft fractures and to discuss their imaging characteristics and clinical significance.Methods A retrospective study was performed in 21 patients with tibial shaft fracture who had received intraoperative intramedullary nailing after limited open reduction at Department of Orthopaedics,The Second Affiliated Hospital to Anhui Medical University from November 2013 to June 2018.They were 14 males and 7 females,aged from 2l to 66 years(average,34.9 years).There were 15 left and 6 right sides.Firstly,closed reduction was performed followed by traction,folding and rotation,but repeated attempts failed to achieve smooth reduction or insertion of guide wire.Next,local limited open reduction had to be performed for intramedullary nailing.The X-ray and CT images of the tibial fractures were collected to analyze their imaging characteristics.The imaging manifestations were characterized into 4 types:single-segment type with intact fibula,multiple-segment type,interlocking type where the distal and proximal ends interlock commonly seen in short spiral and short oblique fractures,and incarceration type where the fracture interspace is blocked by a bone fragment.The therapeutic efficacy was evaluated at the final follow-up by knee scores of The Hospital for Special Surgery(HSS)and Kofoed ankle scores.Results Of the 21 patients,2 were single-segment type,4 multiple-segment type,13 interlocking type and 2 incarceration type.They were followed up for 7 to 50 months(average,22.7 months).The fractures united after 5 to 16 months(average,7.3 months).Postoperative knee pain was observed in 3 cases and delayed fracture union in 2.Osteomyelitis,superficial wound infection,implant breakage or malunion occurred in none of the patients.The therapeutic efficacy evaluated at the final follow-up by HSS knee scores and Kofoed ankle scores revealed 15 excellent,4 good and 2 fair cases,yielding an excellent to good rate of 90.5%.Conclusion The concept of irreducible tibial shaft fractures may lead to preoperative awareness on the part of the surgeons so that ineffective repeated reductions can be spared and the damage to the blood supply to the fracture ends and the operation time can be reduced.
作者
许新忠
赵耀
张积森
徐春归
叶曙明
谢武昆
余水生
荆珏华
Xu Xinzhong;Zhao Yao;Zhang Jisen;Xu Chungui;Ye Shuming;Xie Wukun;Yu Shuisheng;Jing Juehua(Department of Orthopaedics,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第8期722-726,共5页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
膝关节
踝关节
影像学
难复性
Tibia fracture
Knee joints
Ankle joints
Imaging characteristics
Irreducible
作者简介
通信作者:荆珏华,Email:xxzcq1979@163.com
