前交叉韧带重建患者中 Segond 骨折的发生率及预后意义。
Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction.
机构信息
Faculty of Medicine, University of Bergen, Bergen, Norway.
Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.
出版信息
Am J Sports Med. 2020 Apr;48(5):1063-1068. doi: 10.1177/0363546520905557. Epub 2020 Mar 2.
BACKGROUND
The Segond fracture is an avulsion of the anterolateral tibia that can be found in patients with an anterior cruciate ligament (ACL) tear. It is currently unclear if the Segond fracture needs treatment or if it heals spontaneously and if it is associated with an increased risk of failure after ACL reconstruction.
PURPOSE
To identify the incidence and spontaneous healing rate of Segond fractures in a consecutive cohort of patients undergoing ACL reconstruction and to examine the predictive value of the Segond fracture on the risk of undergoing revision surgery.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A retrospective review of a cohort undergoing isolated ACL reconstruction between 2002 and 2016 was performed. Radiographs from the time of injury and preoperative radiographs were evaluated for Segond fractures and healed Segond fractures. Descriptive data were extracted from an internal quality database. Statistical analyses were performed to investigate risk of revision surgery and to compare across subgroups of patients.
RESULTS
A total of 1364 patients were included in the study. The incidence of Segond fractures was 7.4%. In addition, 10.4% of patients displayed signs of healed Segond fractures. In total, 15.2% of patients had either 1 or both findings. The overall healing response of the fracture was 35.6%. Those with Segond fractures were older ( = .014) and had a shorter interval from injury to surgery ( = .003) as compared with the rest of the cohort. The incidence of Segond fractures was significantly higher in those injured during downhill skiing as compared with other injury mechanisms ( = .04). The Segond fracture did not represent an increased risk of undergoing revision when compared with the control group (not significant).
CONCLUSION
The incidence of conventional Segond fractures in patients with ACL injury was found to be in accordance with former studies. Accounting for the high incidence of healed Segond fractures, a much higher incidence (15%) was seen. Although the spontaneous healing rate from initial radiographs to preoperative imaging was only 36%, the presence of Segond fractures did not represent a higher risk of undergoing revision surgery.
背景
Segond 骨折是前交叉韧带（ACL）撕裂患者中前胫骨外侧撕脱骨折。目前尚不清楚 Segond 骨折是否需要治疗，或者是否会自行愈合，以及它是否与 ACL 重建后失败的风险增加有关。
目的
确定连续 ACL 重建患者中 Segond 骨折的发生率和自发愈合率，并研究 Segond 骨折对接受翻修手术风险的预测价值。
研究设计
队列研究；证据等级，3 级。
方法
对 2002 年至 2016 年间接受单纯 ACL 重建的患者进行回顾性队列研究。对损伤时和术前的 X 线片进行评估，以确定是否存在 Segond 骨折和愈合的 Segond 骨折。从内部质量数据库中提取描述性数据。进行统计学分析以研究翻修手术的风险，并对不同亚组患者进行比较。
结果
共纳入 1364 例患者。Segond 骨折的发生率为 7.4%。此外，10.4%的患者有愈合的 Segond 骨折的迹象。总的来说，15.2%的患者存在上述 1 种或 2 种情况。骨折的整体愈合率为 35.6%。与其余队列相比，Segond 骨折患者年龄较大（P =.014），受伤至手术的间隔时间较短（P =.003）。与其他损伤机制相比，在下坡滑雪时受伤的患者 Segond 骨折的发生率明显更高（P =.04）。与对照组相比，Segond 骨折并不代表翻修的风险增加（无统计学意义）。
结论
ACL 损伤患者中常规 Segond 骨折的发生率与既往研究一致。考虑到愈合的 Segond 骨折的高发率，其发生率（15%）更高。尽管初始 X 线片到术前影像学的自发愈合率仅为 36%，但 Segond 骨折并不代表更高的翻修手术风险。
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