Guler Ferhat, Kose Ozkan, Erol Bekir, Turan Adil, Koroglu Mert, Akalin Serdar
Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Kultur mah. 3805 Sk. Durukent Sit., F Blok Daire 22, Kepez, Antalya, Turkey.
Eur J Orthop Surg Traumatol. 2015 Jan;25(1):141-8. doi: 10.1007/s00590-014-1465-5. Epub 2014 Apr 24.
The purpose of this prospective study was to examine the prevalence of occult knee injuries in patients with ipsilateral tibial shaft fractures and determine their impact on clinical outcome.
Preoperative knee MRI examination was performed in 41 patients (42 knees) with isolated tibial shaft fractures. Menisci, cruciate ligaments, collateral ligaments, extensor mechanism, osteochondral lesions, bone contusions and knee effusion were evaluated. All patients were treated with reamed and locked intra-medullary tibial nailing without an additional surgical procedure for knee injuries. All patients were followed to at least fracture union and were evaluated with knee examination and Lysholm knee score.
Of the 42 knees, 41 (97.6 %) showed at least one defined injury around the knee. There was only one patient who had totally normal knee MRI findings. One or more ligamentous injuries of the knee were identified in 35 (83.3 %) of the knees. Five patents (11.9 %) had medial meniscal tear in posterior horn. Extensor mechanism injuries were seen in two patients. Mild to marked joint effusion was observed in 35 (81 %) knees. Twenty-two knees demonstrated bone bruise; femoral condyle (n = 7), tibial plateau (n = 12), patella (n = 2) and fibular head (n = 1). No patients had osteochondral lesion. Patients were followed with a mean of 13.2 ± 3.6 (range 8-22) months. Clinical knee examination revealed Grade II (+) anterior drawer test in two patients. The mean Lysholm knee score was 99.1 ± 2.14 (range 91-100) at the final follow-up.
Ipsilateral intra-articular, extra-articular or combined knee injuries may occur at the time of injury with tibial shaft fractures. However, most of these injuries are not clinically relevant and heal without any sequel or remain asymptomatic late after fracture union. Routine use of preoperative knee MRI examination in patients with tibial shaft fractures is not necessary.
本前瞻性研究旨在调查同侧胫骨干骨折患者中隐匿性膝关节损伤的患病率，并确定其对临床结果的影响。
对41例（42膝）单纯胫骨干骨折患者进行术前膝关节MRI检查。评估半月板、交叉韧带、侧副韧带、伸肌机制、骨软骨损伤、骨挫伤和膝关节积液情况。所有患者均采用扩髓交锁髓内钉治疗胫骨干骨折，未对膝关节损伤进行额外手术。所有患者均随访至骨折至少愈合，并通过膝关节检查和Lysholm膝关节评分进行评估。
42膝中，41膝（97.6%）显示膝关节周围至少有一处明确损伤。仅有1例患者膝关节MRI检查结果完全正常。35膝（83.3%）发现一处或多处膝关节韧带损伤。5例患者（11.9%）后角内侧半月板撕裂。2例患者出现伸肌机制损伤。35膝（81%）观察到轻至重度关节积液。22膝出现骨挫伤；股骨髁（7例）、胫骨平台（12例）、髌骨（2例）和腓骨头（1例）。无患者出现骨软骨损伤。患者平均随访13.2±3.6个月（范围8 - 22个月）。临床膝关节检查发现2例患者前抽屉试验为II级（+）。末次随访时，膝关节Lysholm评分平均为99.1±2.14（范围91 - 100）。
同侧胫骨干骨折损伤时可能发生关节内、关节外或合并的膝关节损伤。然而，这些损伤大多与临床无关，无需任何后续治疗即可愈合，或在骨折愈合后很长时间内仍无症状。对胫骨干骨折患者常规进行术前膝关节MRI检查没有必要。
