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近膝关节骨折并交叉韧带损伤的早期诊断与治疗 |
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张世权 农绍友
【摘要】 目的 探讨近膝关节骨折合并交叉韧带损伤时，避免交叉韧带损伤漏诊的方法。方法 22例胫骨平台及股骨髁骨折患者，于麻醉后或内固定后行膝关节稳定试验，呈阳性者在内固定术同时行膝关节探查及交叉韧带修补术。结果 22例术中抽屉试验均为阳性，与探查结果完全符合。术后经7～46个月随访：所有患者膝关节稳定性良好，抽屉试验阴性，未见创伤性关节炎发生。结论 对有内固定手术指征的近膝关节骨折，术中应检查交叉韧带是否损伤，避免漏诊。
【关键词】交叉韧带损伤；下肢骨折
【中图分类号】 R683.42；686.5 【文献标识码】B
【文章编号】1008-0287(2000)03-0212-02
Early diagnosis and treatment of cruciate ligament injuries associated with fractures near knee joint
Zhang Shiquan ,Nong Shaoyou
(Dept of Orthopaedics,Shenzhen Red Cross Hospital, Shenzhen,Guangdong 518029)
【Abstract】 Objective To investigate the methods to avoid failure to diagnose cruciate ligament injuries assiociated with fractures near knee joint. Methods 22 patients with fractures near knee joint had a knee stability test under anesthesia or after internal fixation during operation,if positive,a exploration of knee joint and repair or reconstruction of cruciate ligament would be performed during same operation. Results The positive rate of knee stability test was 100% in all 22 patients. After 7～46 months of follow-up, knee stability test was negative,there was satisfactory stability of knee joint and no traumatic arthritis was found. Conclusion For patients with fractures near knee joint indicated for an internal fixation, it is necessary to examine if there are cruciate ligament injuries,to avoid failure to diagnose the disease.
【Key words】cruciate ligament injuries; lower extremity fracture
近膝关节的胫骨、股骨髁部骨折是临床上常见的损伤，当合并膝关节交叉韧带损伤时易被忽视而漏诊，从而延误治疗时机，造成不可逆的膝关节损害及功能障碍〔1〕。笔者1996年10月～1999年7月共收治胫骨、股骨髁部骨折合并膝交叉韧带损伤22例，均在早期行骨折内固定术同时修复损伤的韧带，取得满意疗效。
1 材料与方法
1.1 病例资料 本组22例，男17例，女5例，年龄21～47岁。致伤原因：交通事故伤14例，坠落伤6例，重物砸伤和钝器击伤各1例。闭合性损伤19例，开放性损伤3例。股骨内髁骨折3例，均合并前交叉韧带损伤，且为闭合性；胫骨平台骨折19例，合并前交叉韧带损伤17例，后交叉韧带损伤2例，半月板破裂4例，内侧副韧带损伤3例。胫骨平台骨折按Schatzker分类，其中Ⅱ型骨折3例，Ⅲ型骨折6例，Ⅴ型骨折6例，Ⅵ型骨折4例。闭合性损伤病例中浮髌试验（+）14例。本组22例中X线片可见明确胫骨髁间隆突骨折者6例，术前考虑有交叉韧带损伤，其余病例均未考虑有交叉韧带损伤。
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