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[胫骨头部保守及手术治疗后X线及功能状态早期与晚期变化之间的相关性研究]

[Study of the correlation between early and late changes in the roentgenologic and functional status following conservative and surgical treatment of the head of the tibia].

作者信息

Friedl W, Ruf W, Krebs H

机构信息

Chirurgische Universitätsklinik Heidelberg.

出版信息

Unfallchirurgie. 1987 Aug;13(4):192-206. doi: 10.1007/BF02588722.

DOI:10.1007/BF02588722
PMID:3686736
Abstract

Between 1976 and 1980 161 patients were admitted to our department with condylar fractures of the tibia. 60% of the patients were treated conservatively, 40% underwent surgery. The patients follow-up was analysed three to seven years after therapy and an examination of a representative group of patients was performed 1983. A direct comparison of therapeutic results between the conservative and operative treatment groups is not possible, since fractures with a particularly poor prognoses including depression and impression fractures of the articular surface were more frequent in the operative treatment group. It is noteworthy, however, that the patients' activity at work and in their leisure time was increased in the operative group. Additionally in this group the remaining complaints were less and the final results more favourable according to the patients' self-judgment. Unchanged irregularities of the joint surface following initial therapy were found in 40.5% of conservatively treated patients and in 6.9% of operated patients respectively. At the time of reassessment, however, differences of radiological findings could not be seen between the two treatment groups. Whereas in the conservative treatment group a difference in length of the two legs of 2 cm or more were observed in 16% of cases, not a single case was found in the operative treatment group. There was a correlation of the functional and the result of the radiological examination, although considerable exceptions from this correlation were also seen. Therefore it is not possible from the individual X-ray findings to predict the functional results of the patient.

摘要

1976年至1980年间,161例胫骨髁骨折患者住进了我们科室。60%的患者接受了保守治疗,40%接受了手术治疗。在治疗后三至七年对患者进行了随访,并于1983年对一组有代表性的患者进行了检查。由于手术治疗组中包括关节面凹陷和嵌插骨折在内的预后特别差的骨折更为常见,因此无法对保守治疗组和手术治疗组的治疗结果进行直接比较。然而,值得注意的是,手术组患者在工作和休闲时的活动有所增加。此外,根据患者的自我判断,该组的残留症状较少,最终结果更有利。初始治疗后,分别有40.5%的保守治疗患者和6.9%的手术治疗患者关节面存在未改变的不规则情况。然而,在重新评估时,两个治疗组在放射学检查结果上没有差异。保守治疗组中,16%的病例观察到双腿长度差异在2厘米或以上,而手术治疗组未发现一例。功能检查结果与放射学检查结果存在相关性,尽管也有相当多的例外情况。因此,根据个体的X线检查结果无法预测患者的功能结果。

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引用本文的文献

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[Total knee replacement for primary treatment of intra-articular tibial head fractures in elderly patients].[全膝关节置换术用于老年患者关节内胫骨近端骨折的初次治疗]
Unfallchirurg. 2003 Dec;106(12):1046-50. doi: 10.1007/s00113-003-0643-4.
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[Fractures of the proximal tibia and knee ligament injuries].[胫骨近端骨折与膝关节韧带损伤]
Unfallchirurgie. 1994 Apr;20(2):88-93. doi: 10.1007/BF02588149.
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[Dislocation fracture of the head of the tibia. II. Therapeutic procedure].[胫骨头部脱位骨折。II. 治疗方法]

本文引用的文献

1
Fractures of the tibial condyle; a clinical and experimental study.胫骨髁骨折:一项临床与实验研究。
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2
Experimental tibial-plateau fractures. Studies of the mechanism and a classification.实验性胫骨平台骨折。机制研究与分类
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Fractures of the condyles of the tibia. An anatomical and clinical end-result study of one hundred cases.胫骨髁骨折。100例解剖学及临床最终结果研究。
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Hefte Unfallheilkd. 1968;95:1-126.
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[Treatment of tibial head fractures and its results].[胫骨近端骨折的治疗及其结果]
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Fractures of the tibial condyles.胫骨髁骨折
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Fractures of the tibial condyles.胫骨髁骨折
Acta Orthop Scand. 1971;42(5):429-30.
8
[Late results of primary, severely displaced tibial-head fractures (conservative treatment and minimal osteosynthesis)].[原发性严重移位胫骨近端骨折的远期结果(保守治疗和微创接骨术)]
Hefte Unfallheilkd. 1975 Nov(126):299-310.
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[Separation of surgical and conservatuve therapy in tibial-head fractures].[胫骨近端骨折手术治疗与保守治疗的区分]
Hefte Unfallheilkd. 1975 Nov(126):258-9.
10
[Management of impression fractures of the tibial head using plate osteosynthesis].[使用钢板接骨术治疗胫骨近端压缩骨折]
Hefte Unfallheilkd. 1975 Nov(126):256-7.