胫骨干骨折合并同侧后踝骨折X线片漏诊原因分析与手术治疗策略  

Analysis of causes of misdiagnosis in X-ray examination results and surgical strategies of tibial shaft fractures associated with ipsilateral posterior malleolar fractures

作　　者：王刚[1] 白晓冬[1] 刘振宇[1] 许国强 陈文韬[1] 高化[1] 赵亮[1] 李亚东[1] 王宝军[1] WANG Gang;BAI Xiao-dong;LIU Zhen-yu;XU Guo-qiang;CHEN Wen-tao;GAO Hua;ZHAO Liang;LI Ya-dong;WANG Bao-jun(Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;不详)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中国骨与关节损伤杂志》2021年第4期364-367,共4页Chinese Journal of Bone and Joint Injury

基　　金：国家自然科学基金青年科学基金项目(81701203)。

摘　　要：目的探讨胫骨干骨折合并同侧后踝骨折的X线片漏诊原因及其手术治疗策略。方法回顾性分析自2017-05—2019-05手术治疗的27例胫骨干骨折合并同侧后踝骨折,首先采用交锁髓内钉内固定胫骨干骨折,当后踝骨折块面积<25%关节面时骨折可不予以处理,术后采用短腿石膏托进行固定;当后踝骨折块面积≥25%关节面,可以在调整髓内钉远端锁钉位置尝试对后踝骨折块进行复位固定,无法进行有效复位固定时需要采用1或2枚空心钉固定后踝骨折。结果本组X线片检查确诊21例胫骨干骨折合并同侧后踝骨折,6例漏诊,漏诊率为22.2%。27例均获得至少12个月随访,胫骨干骨折愈合时间平均5.2(3~8)个月,后踝骨折愈合时间平均3.1(2~4)个月。末次随访时踝关节功能AOFAS评分:优20例,良4例,可3例。结论临床医师在诊治胫骨干骨折患者时要考虑合并同侧后踝骨折的可能,单纯采用X线片检查此类骨折存在漏诊后踝骨折的风险,建议常规进行三维CT检查,然后根据不同的后踝骨折线位置制定合理的个体化手术治疗方案对患肢功能恢复有重要意义。Objective To investigate the causes of misdiagnosis in X-ray examination results and surgical strategies of tibial shaft fractures associated with ipsilateral posterior malleolar fractures.Methods A total of 27 cases of tibial shaft fractures associated with ipsilateral posterior malleolar fractures were collected from May 2017 to May 2019.First of all,interlocking intramedullary nails were used for internal fixation of tibial shaft fractures.When the area of the posterior malleolar fracture fragments was less than 25%of the articular surface,the fractures could be fixed with plaster fixation after surgery instead of internal fixation.When the area of the posterior malleolar fractures fragments was greater than or equal to 25%of the articular surface,the fracture fragments could be reduced and fixed by adjusting the location of the distal locking nails of the intramedullary nails.Otherwise,1 or 2 cannulated screws should be used to fix the posterior malleolar fracture fragments.Results Twentyone cases of tibial shaft fractures associated with ipsilateral posterior malleolar fractures were diagnosed by X-ray examinations,6 cases were missed diagnosis and the misdiagnosis rate was 22.2%.All 27 cases were followed up for at least 12 months.The healing time of tibial shaft fracture ranged from 3 to 8 months,with an average of 5.2 months.The healing time of posterior malleolar fracture ranged from 2 to 4 months,with an average of 3.1 months.In the last follow-up,the results were excellent in 20cases,good in 4 and fair in 3 according to the scoring system of AOFAS.Conclusion Clinicians should be alert to the possibility of concomitant ipsilateral posterior malleolar fractures in the treatment of tibial shaft fractures.There may be missed diagnoses in X-ray examinations,therefore it is suggested that three-dimensional CT scans should be performed routinely.It is of great significance to make a reasonable individualized surgical treatment plan according to different positions of posterior malleolar fractures lines for th

关 键 词：胫骨干骨折 后踝骨折 漏诊 交锁髓内钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]