SchatzkerⅣ型胫骨平台骨折伴前交叉韧带断裂漏诊分析
Analysis of Missed Diagnosis of Schatzker Type Ⅳ Tibial Plateau Fracture with Anterior Cruciate Ligament Rupture
张澎 1肖毅 2谢文鹏3
作者信息
- 1. 250014 济南,山东中医药大学第一临床医学院
- 2. 250014 济南,山东中医药大学附属医院微创骨科
- 3. 250014 济南,山东中医药大学附属医院 运动损伤骨科
- 折叠
摘要
目的 探讨SchatzkerⅣ型胫骨平台骨折伴前交叉韧带断裂临床特点及漏诊原因、防范措施.方法 回顾性分析2022 年1-12 月收治的曾漏诊的SchatzkerⅣ型胫骨平台骨折伴前交叉韧带断裂13 例的临床资料.结果 本组受伤后均于急诊科就诊,行膝关节X线或CT检查诊断胫骨平台骨折SchatzkerⅣ型,皆行胫骨平台骨折切开复位内固定术.骨折愈合良好,后入院取内固定物,诉膝关节不稳定,行膝关节MRI检查后结合病史诊断前交叉韧带断裂.3 例行保守治疗症状明显减轻;10 例接受前交叉韧带重建手术,术后 1 个月膝关节屈曲(109.40±13.55)°,Lysholm膝关节评分(83.77±6.80)分,国际膝关节评分委员会评分(80.38±9.51)分.漏诊时间 11～17(13.10±1.79)个月.结论 SchatzkerⅣ型胫骨平台骨折伴前交叉韧带断裂易漏诊.临床遇及类似本文患者检查时应特别注意膝关节周围软组织损伤,要常规行膝关节MRI检查,术中可予膝关节镜辅助,骨折固定完成后于麻醉状态下查体,以减少或避免前交叉韧带断裂漏诊.
Abstract
Objective To investigate the clinical characteristics,causes of missed diagnosis and preventive measures of Schatzker type Ⅳ tibial plateau fracture with anterior cruciate ligament rupture.Methods The clinical data of 13 patients with Schatzker type Ⅳ tibial plateau fracture with anterior cruciate ligament rupture,which had been missed in our hospital from January to December 2022,were retrospectively analyzed.Results All patients were treated in the Emergency Depart-ment after injury.X-ray or CT examination of the knee joint was performed to diagnose Schatzker type Ⅳ tibial plateau frac-ture.All cases underwent open reduction and internal fixation of tibial plateau fracture.After the fracture healed well,she was admitted to hospital for internal fixation and complained of instability of the knee joint.After knee MRI examination combined with medical history,she was diagnosed with anterior cruciate ligament rupture,and the symptoms of three patients were sig-nificantly reduced after conservative treatments.Ten patients underwent anterior cruciate ligament reconstruction,knee flexion(109.40±13.55)° at1 month after surgery,Lysholm knee joint score(83.77±6.80)score,and International Knee Joint Scoring Committee score(80.38±9.51)score.The missed diagnosis lasted11 to17(13.10±1.79)months.Conclusion Schatzker typeⅣtibial plateau fracture with anterior cruciate ligament rupture is more likely to be missed.Special attention should be paid to the soft tissue injury around the knee joint during the clinical examination of patients similar to those de-scribed in this article.MRI of the knee joint should be routinely performed,knee arthroscopy can be assisted during the opera-tion,and physical examination under anesthesia after fracture fixation is completed to reduce or avoid missed diagnosis of ante-rior cruciate ligament rupture.
关键词
胫骨骨折/SchatzkerⅣ型/前交叉韧带/断裂/漏诊/前交叉韧带重建/体层摄影术,螺旋计算机/磁共振成像Key words
Tibial fractures/Schatzker type Ⅳ/Anterior cruciate ligament/Fracture/Missed diagnosis/Anterior cruciate ligament reconstruction/Tomography,spiral computed/Magnetic resonance imaging引用本文复制引用
基金项目
山东省自然科学基金青年项目(ZR2020QH312)
出版年
2023
国家科技期刊平台
NSTL
万方数据