胫骨下段螺旋形骨折并后踝骨折漏诊原因及治疗策略  

The Cause of Missed Diagnosis and Treatment Strategies of Spiral Distal Tibial Fracture Accompanied by Posterior Malleolus Fracture

作　　者：王振堂[1] 焦顺成[1] 申海波[1] 吴艳刚[1] 刘艳梅[1] 董军政[1] 

机构地区：[1]北京市顺义区医院骨一科,北京101300

出　　处：《临床误诊误治》2011年第8期55-56,共2页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨胫骨下段螺旋形骨折合并后踝骨折的漏诊原因及治疗策略。方法回顾性分析2008年1月～2009年11月收治的11例胫骨下段螺旋形骨折合并后踝骨折的诊治过程。结果7例于术前发现后踝骨折，其余4例分别于术中、术后发现。经皮空心钉内固定8例，石膏外固定2例，1例因骨折块小未予内固定I术后未发现骨折块明显移位，亦未行外固定。平均随访13．2个月，后踝骨折均获骨性愈合，1例石膏外固定者发生创伤性关节炎。结论胫骨下段螺旋形骨折常合并隐匿的后踝骨折，单纯X线检查易漏诊，CT检查可明确诊断。后踝骨折超过胫骨远端关节面25％者，可行经皮空心钉内固定治疗。Objective To investigate the misdiagnosis cause and treatment strategies of spiral distal tibial fracture accompanied by posterior malleolus fracture. Methods The diagnosis and treatment process of 11 patients with spiral distal tibial fracture and posterior malleolus fracture admitted to our hospital during January 2008 and November 2009 were retrospectively analyzed. Results Malleolus fracture was diagnosed in 7 patients preoperatively, and the others were diagnosed during and after surgeries respectively. Percutaneous cannulated screws fixation of the fragment was performed in 8 patients, and plaster fix- ation was performed in 2. A patient without internal fixation for too small fractured bone block was found with fracture displacement, but external fixation was not performed. The mean duration of follow-up was 13.2 months. All the posterior malleolus fractures healed, but one patient suffered from traumatic arthritis after plaster fixation. Conclusion The spiral distal tibial fracture is frequently associated with ipsilateral posterior malleolus fracture in clinical practice, and it is easily missed diagnosed with X-ray. CT scanning can be used in diagnosis. Pereutaneous cannulated screw fixation can be used to treat posterior malleolus fracture when the fragment constitutes more than 25% of the tibiotalar joint surface.

关 键 词：胫骨骨折 骨折 漏诊 临床方案 

分 类 号：R687.3[医药卫生—骨科学]