摘要
目的 探讨Schatzker Ⅳ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Schatzker Ⅳ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Schatzker Ⅳ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 Schatzker Ⅳ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。
Objective To investigate the clinical characteristics,causes of missed diagnosis and preventive measures of Schatzker typeⅣtibial plateau fracture with anterior cruciate ligament rupture.Methods The clinical data of 13 patients with Schatzker typeⅣtibial 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 Department after injury.X-ray or CT examination of the knee joint was performed to diagnose Schatzker typeⅣtibial plateau fracture.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 significantly reduced after conservative treatments.Ten patients underwent anterior cruciate ligament reconstruction,knee flexion(109.40±13.55)°at 1 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 lasted 11 to 17(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 described in this article.MRI of the knee joint should be routinely performed,knee arthroscopy can be assisted during the operation,and physical examination under anesthesia after fracture fixation is completed to reduce or avoid missed diagnosis of anterior cruciate ligament rupture.
作者
张澎
肖毅
谢文鹏
ZHANG Peng;XIAO Yi;XIE Wenpeng(The First School of Clinical Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Department of Minimally Invasive Orthopedics,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Department of Orthopedics and Sports Injury,the Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)
出处
《临床误诊误治》
CAS
2023年第8期22-25,39,共5页
Clinical Misdiagnosis & Mistherapy
基金
山东省自然科学基金青年项目(ZR2020QH312)。
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
Tibial fractures
Schatzker typeⅣ
Anterior cruciate ligament
Fracture
Missed diagnosis
Anterior cruciate ligament reconstruction
Tomography,spiral computed
Magnetic resonance imaging
