[1]凌中华,冯金柱△.胫骨干骨折合并隐匿性后踝骨折情况及危险因素[J].中国中医骨伤科杂志,2024,32(05):41-45+49.[doi:10.20085/j.cnki.issn1005-0205.240508]
　LING Zhonghua,FENG Jinzhu.Tibial Shaft Fracture Combined with Occult Posterior Malleolar Fracture and Risk Factors[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(05):41-45+49.[doi:10.20085/j.cnki.issn1005-0205.240508]
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胫骨干骨折合并隐匿性后踝骨折情况及危险因素()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年05期
页码:
41-45+49
栏目:
临床研究
出版日期:
2024-05-15

文章信息/Info

Title:
Tibial Shaft Fracture Combined with Occult Posterior Malleolar Fracture and Risk Factors
文章编号:
1005-0205(2024)05-0041-05
作者:
凌中华1; 冯金柱2△
1上海健康医学院附属崇明医院(上海,202150)
2东部战区总医院
Author(s):
LING Zhonghua1; FENG Jinzhu2△
1Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 202150,China; 2Eastern Theater General Hospital,Nanjing 210002,China.
关键词:
胫骨干骨折;  隐匿性后踝骨折;  螺旋骨折;  远端骨折;  危险因素
Keywords:
tibial shaft fracture;  concealed posterior ankle fracture;  spiral fracture;  distal fracture;  risk factor
分类号:
R683.42
DOI:
10.20085/j.cnki.issn1005-0205.240508
文献标志码:
A
摘要:
目的:分析胫骨干骨折患者合并隐匿性后踝骨折情况及其危险因素。方法:前瞻性选取2018年3月至2023年1月收治的120例胫骨干骨折患者作为研究对象,分别采用X线、CT及MRI对患者进行检查,统计不同检查方式对隐匿性后踝骨折的检出率。根据影像学检查结果按照有无合并隐匿性后踝骨折分为发生组和未发生组,统计两组患者的一般资料,采用单因素分析和多因素Logistic回归分析影响隐匿性后踝骨折发生的危险因素。结果:120例患者中共计检出42例患者合并隐匿性后踝骨折,发生率为35.00%(42/120); 发生组胫骨骨折线长度及骨折线最低点至胫-距关节面距离长于未发生组,非螺旋骨折及骨折部位在远端的发生率均高于未发生组(P<0.05); 胫骨骨折线长度、骨折线最低点至胫-距关节面距离、非螺旋形骨折及远端骨折为合并隐匿性后踝骨折的相关因素(OR=0.921,0.808,2.684,17.762; 95%CI分别为0.797～0.819,0.914～0.927,2.215～3.254,14.317～22.037)(P<0.05)。结论:胫骨干骨折患者合并隐匿性后踝骨折发生率为35.00%,骨折线最低点至胫-距关节面距离、胫骨骨折线长度、非螺旋形骨折及远端骨折为合并隐匿性后踝骨折的相关因素。
Abstract:
Objective:To analyze the situation and risk factors of patients with tibial shaft fracture complicated with occulted posterior malleolar fracture.Methods:A total of 120 patients with tibia shaft fracture from March 2018 to January 2023 were prospectively selected as the study objects.X-ray,CT and MRI were used to examine the patients,respectively,and the detection rate of occulted posterior ankle fracture was calculated by different examination methods.According to the imaging results,the patients were divided into the occurrence group and the non-occurrence group according to whether there were concealed posterior ankle fractures.The general data of the two groups were analyzed,and the risk factors affecting the occurrence of concealed posterior ankle fractures were analyzed by univariate analysis and multivariate Logistic regression analysis.Results:A total of 42 patients with concealed posterior malleolar fracture were detected,the incidence was 35.00%(42/120).The length of the tibial fracture line and the distance from the lowest point of the fracture line to the tibia-distal articular surface were longer in the occurrence group than in the non-occurrence group.The incidence of non-spiral fracture and the distal fracture site were higher than those in the non-occurrence group(P<0.05).The length of the tibial fracture line,the distance from the lowest point of the fracture line to the tibia-distal articular surface,non-spiral fracture,and distal fracture were associated with ocessive posterior malleolar fracture(OR=0.921,0.808,2.684,17.762,0.808,2.684,17.762; 95%CI were 0.797-0.819,0.914-0.927,2.215-3.254,14.317-22.037)(P<0.05).Conclusion:The incidence rate of patients with tibial shaft fracture complicated with occulted posterior malleolar fracture was 35.00%.The distance from the lowest fracture line to the tibia-distal articular surface,the length of the tibial fracture line,non-spiral fracture and distal fracture were the related factors.

参考文献/References:

[1] 苏琳,徐强,高梦徽,等.769例成人胫骨平台骨折流行病学特征分析[J].中国骨与关节损伤杂志,2021,36(4):439-440.
[2] HENDRICKX L,CAIN M E,SIEREVELT I N,et al.Incidence,predictors,and fracture mapping of(Occult)posterior malleolar fractures associated with tibial shaft fractures[J].J Orthop Trauma,2019,33(12):e452-e458.
[3] 高彦军,贾斌,张勇,等.胫腓骨骨折合并后踝骨折的损伤机制和治疗[J].中国矫形外科杂志,2013,21(8):816-818.
[4] 马许宁,王玲娟,李源,等.MSCT及MRI检查对踝关节隐匿性骨折的临床应用价值分析[J].中国CT和MRI杂志,2021,19(7):149-151.
[5] WANG D,YANG J,DONG X,et al.Incidence and predictive factors of tibial fracture with occult posterior ankle fractures[J].J Healthc Eng,2021,21(8):4392595.
[6] MAGAN P,CHIN SEE C,CLARKE D,et al.Rupture of the tibialis posterior tendon with associated bimalleolar ankle fracture[J].Cureus,2022,14(11):e31886.
[7] YANG T C,TZENG Y H,WANG C S,et al.Untreated small posterior fragment of ankle fracture with early removal of syndesmotic screw is associated with recurrent syndesmotic instability[J].Injury,2021,52(3):638-643.
[8] 王刚,白晓冬,刘振宇,等.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[J].中国骨与关节损伤杂志,2021,36(4):364-367.
[9] 陈光辉,商科,刘伟.胫腓骨骨折合并后踝骨折的损伤机制和治疗方法[J].临床医药文献电子杂志,2019,6(3):17-18.
[10] 王栋栋,陈凯,孙宏志,等.难复性胫腓骨骨折治疗研究进展[J].创伤外科杂志,2019,21(5):393-396.
[11] 张静雅,刘宁,刘爽,等.隐匿性胫骨平台骨折MRI、CT检查的影像学表现及其诊断价值对比的回顾性研究[J].现代生物医学进展,2021,21(6):1085-1088.
[12] 张军胜,赵波.多层螺旋CT对膝关节损伤后胫骨平台隐匿性骨折早期诊断的效果及价值[J].解放军医药杂志,2018,30(8):96-99.
[13] WANG Z,CHEN W,ZHU Y,et al.Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures:a systematic review[J].J Orthop Surg Res,2021,16(1):355.
[14] BIDOLEGUI F,PEREIRA S,GARABANO G,et al.Distal articular involvement in tibial shaft fractures:an evaluation of 125 consecutive cases[J].Eur J Orthop Surg Traumatol,2023,33(2):335-340.
[15] 黄兆海,陈杨宗.MRI与多层螺旋CT对胫骨下1/3螺旋骨折伴后踝隐匿性骨折的诊断价值比较[J].浙江创伤外科,2018,23(4):822-823.
[16] JUNG G H,CHUNG H,BAEK S H,et al.Percutaneous bridge plating of extra-articular distal fibular fracture for the management of distal tibia type Ⅲ open fracture[J].Asian J Surg,2021,44(1):363-368.
[17] 安晓,李志锐,马睿,等.不同A型胫骨干骨折的手术疗效及合并踝关节损伤发生率比较[J].解放军医学院学报,2018,39(5):397-399.
[18] WARNER S J,GARNER M R,SCHOTTEL P C,et al.The effect of soft tissue injuries on clinical outcomes after tibial plateau fracture fixation[J].J Orthop Trauma,2018,32(3):141-147.
[19] MYATT D,STRINGER H,CHAPMAN J,et al.Prediction of distal tibial articular extension in tibial shaft fractures:both posterior malleolar fracture and non posterior malleolar fracture intra-articular extension[J].Eur J Trauma Emerg Surg,2023,49(2):903-910.
[20] 王建朝,李升,刘国彬,等.胫腓骨远端骨硬度分布特征研究[J].中华骨与关节外科杂志,2019,12(11):864-867.
[21] FISHER N D,BI A S,PAROLA R,et al.Fracture obliquity angle and distance from plafond:novel radiographic predictors of posterior malleolar involvement in tibial shaft fractures[J].Eur J Orthop Surg Traumatol,2023,33(5):1937-1943.
[22] 廖维,王广,张有强,等.张-侯氏骨折的影响因素分析[J].中国医药导报,2022,19(27):80-83.
[23] 郭家良,董天华,殷兵,等.三踝骨折与胫腓骨螺旋骨折中后踝骨折的回顾性研究[J].河北医科大学学报,2018,39(12):1403-1406.
[24] 蔡华琦,万业达,Koiral,等.X线数字断层融合成像在胫骨平台骨折Schatzker分型诊断中的价值[J].中华骨科杂志,2018,38(11):8.

备注/Memo

备注/Memo:
△通信作者 E-mail:ffengjinzhu@163.com
更新日期/Last Update: 2024-05-15