膝关节后脱位并胫骨平台前缘骨折25例报道

陈斌; 陈洁; 徐永清; 张颖; 王成勇; 丁晶

膝关节后脱位并胫骨平台前缘骨折25例报道

1. 成都军区昆明总医院全军骨科研究所全国重点专科
2. 成都军区昆明总医院医学影像科

基金项目:

基金：全军医药卫生科研基金资助项目(06MAId O); 军队临床高新技术重大项目(20109xjs IMI);

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出版历程
- 收稿日期: 2016-05-01

Posterior Keen Dislocation with Anterior Tibial Plateau Fracture:Report of 25 Cases

Funds:

基金：全军医药卫生科研基金资助项目(06MAId O); 军队临床高新技术重大项目(20109xjs IMI);

摘要

摘要: 目的探讨新型膝关节骨折脱位类型-膝关节后脱位并胫骨平台前缘骨折的损伤机制,为临床诊断及治疗提供理论支持,提高治疗效果.方法 2009年6月至2012年6月,收集膝关节后脱位并胫骨平台前缘骨折病例25例,详细询问病史,结合X片、CT扫描、MRI检查及术中所见,从物理力学的角度分析受伤机制.结果25例中13例为高处坠落伤(约2~5 m),10例为车祸损伤,1例为背重物时摔倒受伤,1例为山坡滚落伤,脱位类型均为后脱位,均伴有胫骨平台前缘骨折,其中5例伴有腓总神经损伤并腘动脉断裂,1例伴有腓骨头骨折,其余病例无明显血管神经损伤症状。该组患者受伤时膝关节均位于屈曲位,膝关节脱位后的股骨髁向前滑动,骑跨于胫骨平台前缘,造成胫骨平台前缘骨折.术后1 a复查,膝关节HSS评分平均分为88.5分,优良率93.7%.结论膝关节后脱位并胫骨平台前缘骨折主要损伤原因为高能量创伤是一种新型膝关节骨折脱位类型.对于膝关节后脱位者,术前要仔细查看胫骨平台前缘是否有骨折存在,避免漏诊;术中要恢复骨折块的解剖位置以提高手术效果.
- 膝关节脱位 /
- 胫骨平台 /
- 骨折
Abstract: Objective To discuss the injury mechanisms of posterior keen dislocation with anterior tibial plateau fracture and to provide theoretic support for clinic diagnosis and treatment. Methods Total of 25 cases with posterior knee dislocation and anterior tibial plateau fracture were enrolled from June,2009 to June,2012. Injury mechanisms were analyzed from the point of view of mechanics by combining with detailed histories,X-ray,CT scan and MRI results, and surgical findings.Results All of 25 cases were high-energy injury,with 13 falling from heights(about 2-5 meters),10 injured in traffic accident, 1 falling down by carrying heavy backpacks and 1rolling down hill. Posterior knee dislocation with the anterior tibial plateau fracture were found in all the 25 cases,among which 5 cases were with common peroneal nerve injury and popliteal artery rupture,and 1 case was with capitulum fibulae fracture and the rest were with no obvious artery nerve injury One years after operation,the average HSS score of the knee joint was 88.5 and the excellent and good rate was 93.7%. Conclusion The main reason of the backward dislocation of knee joint with the anterior border fracture of tibial plateau was high energy trauma and it was a new type of fracture-dislocation of knee joint. After backward dislocation of knee joint, we should carefully check whether there is the anterior-edge fracture of tibial plateau before operation to avoid misdiagnosis; reduction of the anterior-edge fracture of tibial plateau must be done Anatomically in operation,which can reduce the occurrence ofinstability of knee joint after operation and improve the operation effect
- Knee dislocation /
- Tibial plateau /
- Fracture

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参考文献(15)

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