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胫骨平台骨折(AO B3型)合并胫骨结节骨折:病例报告及文献复习

Tibial plateau fractures (AO type B3) combined with tibial tubercle fracture: Case report and review of the literature.

作者信息

Tan Lei, Li Yan-Hui, Li Yuying, Lin Tong, Zhu Dong, Sun Da-Hui

机构信息

Department of Orthopedic Trauma Department of Cardiology and Echocardiography Department of Hematology, The First Hospital of Jilin University, Changchun, China.

出版信息

Medicine (Baltimore). 2018 Sep;97(36):e12015. doi: 10.1097/MD.0000000000012015.

DOI:10.1097/MD.0000000000012015
PMID:30200081
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6133641/
Abstract

RATIONALE

Tibial tuberosity fractures most often occur in the adolescents. Fracture of tibial tuberosity in adults is extremely rare with only 5 reported cases till date. Tibial plateau fractures combined with tibial tubercle fractures are not common.

PATIENT CONCERNS

We report here a type B3 tibial plateau fracture (AO classification) with a concomitant fracture of tibial tuberosity.

DIAGNOSES

Anteroposterior and lateral knee view radiographs revealed a complex comminuted fracture of the right tibial plateau (AO Type B3; Schatzker Type IV) with tibial tubercle fracture. Three-dimensional computed tomography (CT) showed that the tibial media plateau was split into 2 pieces in the sagittal plane, along with the isolated tibial tubercle.

INTERVENTIONS

The open procedure was performed first and a standard posteromedial approach for medial and posteromedial tibial plateau fracture was used with double locking plate fixation. The tibial tuberosity was fixed with a cortical screw.

OUTCOMES

The patient showed full range of motion in right knee after 8 weeks. The patient was allowed full weight bearing at 4 months. Eight months after operation, he was asymptomatic, showed a full range of motion and good strength. He had returned to work with no limitations.

LESSONS

Fractures of the partial tibial plateau combined with tibial tubercle are present and should not be ignored. Accurate diagnosis and proper treatment will help achieve favorable outcomes in these patients.

摘要

理论依据

胫骨结节骨折最常发生于青少年。成人胫骨结节骨折极为罕见,迄今为止仅有5例报道。胫骨平台骨折合并胫骨结节骨折并不常见。

患者情况

我们在此报告1例B3型胫骨平台骨折(AO分类)合并胫骨结节骨折的病例。

诊断

膝关节正侧位X线片显示右胫骨平台复杂粉碎性骨折(AO B3型;Schatzker IV型)伴胫骨结节骨折。三维计算机断层扫描(CT)显示胫骨内侧平台在矢状面分成2块,伴有孤立的胫骨结节。

干预措施

首先进行切开手术,采用标准的后内侧入路治疗胫骨内侧和后内侧平台骨折,使用双锁定钢板固定。胫骨结节用一枚皮质骨螺钉固定。

结果

患者8周后右膝关节活动范围正常。4个月时允许完全负重。术后8个月,患者无症状,活动范围正常且力量良好。他已恢复工作,无任何限制。

经验教训

部分胫骨平台骨折合并胫骨结节骨折确实存在,不应被忽视。准确的诊断和恰当的治疗有助于这些患者获得良好的治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/27683cf5d0b2/medi-97-e12015-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/2daa1fc74e74/medi-97-e12015-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/e98dec0be3b2/medi-97-e12015-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/27683cf5d0b2/medi-97-e12015-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/2daa1fc74e74/medi-97-e12015-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/e98dec0be3b2/medi-97-e12015-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a5c/6133641/27683cf5d0b2/medi-97-e12015-g003.jpg

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本文引用的文献

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Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult: A Case Report and Literature Review.成人胫骨结节撕脱骨折与开放性胫骨近端骨折:一例报告及文献综述
Medicine (Baltimore). 2015 Sep;94(39):e1684-0. doi: 10.1097/MD.0000000000001684.
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[Application of cannulated compression screws for the treatment of tibial tubercle avulsion fractures of Ogden type III in adolescents].空心加压螺钉在青少年OgdenⅢ型胫骨结节撕脱骨折治疗中的应用
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Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau.
低剂量 CT 和 MRI 在评价胫骨平台骨折软组织损伤中的应用。
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