Segond骨折及其合并症的外科治疗  

SURGICAL TREATMENT OF Segond FRACTURE AND COMPLICATIONS

作　　者：赵波[1] 冉霞[2] 张铭华[1] 何超[1] 蒋电明[3] 

机构地区：[1]重庆医科大学附属永川医院骨科,重庆永川402160 [2]重庆医科大学附属永川医院肾内科,重庆永川402160 [3]重庆医科大学附属第一医院骨科

出　　处：《中国修复重建外科杂志》2013年第9期1045-1049,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨Segond骨折及其合并症的致伤机制、临床特点和治疗方法。方法 2007年1月-2011年12月,收治15例Segond骨折患者。男10例,女5例;年龄16～50岁,平均31.8岁。致伤原因:交通事故伤8例,运动伤6例,重物砸伤1例。术前膝关节活动度(36.60±8.94)°,膝关节功能Lysholm评分为(32.27±3.73)分,国际膝关节文献委员会(IKDC)评分为(42.34±4.97)分。受伤至手术时间1～3周,平均1.2周。合并前交叉韧带体部撕裂12例,行关节镜下同种异体胫前肌腱移植重建术;2例胫骨髁间棘撕脱骨折,行关节镜下骨折复位Orthocord线捆绑固定术。合并半月板损伤8例,3例行半月板缝合术,5例行半月板成形术。合并侧副韧带损伤7例,5例行保守治疗,2例行切开内侧副韧带可吸收线缝合修补术。所有Segond骨折块均未处理。结果术后患者切口均Ⅰ期愈合,无切口感染及神经、血管损伤等早期并发症发生。15例均获随访,随访时间12～16个月,平均14.3个月。术后12个月,患者膝关节前抽屉试验、Lachman试验、侧方应力试验均为阴性。膝关节活动度为(129.27±5.89)°;Lysholm评分和IKDC评分均明显提高,分别达(87.87±4.12)分和(89.45±3.05)分;与术前比较差异均有统计学意义(P<0.05)。结论 Segond骨折常伴前交叉韧带、侧副韧带及半月板损伤,其对膝关节内联合损伤具有提示作用,应根据具体损伤情况选择个体化治疗方案。Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years （mean, 31.8 years）. Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion （ROM） was （36.60 ± 8.94）°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee （IKDC） score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament （ACL） injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months （mean, 14.3 months）. At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was （129.27 ± 5.89）°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values （P 〈 0.05）. Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can strongly s

关 键 词：SEGOND骨折 前交叉韧带损伤 侧副韧带损伤 半月板损伤 关节镜 

分 类 号：R687.3[医药卫生—骨科学]