Tytherleigh-Strong G M, Keating J F, Court-Brown C M
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, UK.
J R Coll Surg Edinb. 1997 Oct;42(5):334-8.
In a study of 523 consecutive tibial fractures, 33 were located in the proximal extra-articular segment. There were two fracture groups with different epidemiological characteristics and prognoses: group 1 fractures were metaphyseal in location, follow low-velocity injuries and have a good prognosis with non-operative treatment; group 2 injuries are high-energy diaphyseal fractures. Treatment of these latter fractures proved difficult, with all methods showing significant complications. Overall there was a 26% incidence of malunion, 7% deep infection and 7% compartment syndrome. Only 44% of patients with group 2 fractures returned to full function. Epidemiological analysis showed that proximal tibial fractures are closer to comminuted and segmental fractures in severity than to middle- and distal-third fractures. It is suggested, on the basis of our results, that they should be treated with either compression plating or closed external fixation.
在一项对523例连续性胫骨骨折的研究中，33例位于近端关节外段。存在两组具有不同流行病学特征和预后的骨折：第1组骨折位于干骺端，继发于低能量损伤，非手术治疗预后良好；第2组损伤为高能量骨干骨折。事实证明，治疗这些骨折很困难，所有方法都显示出明显的并发症。总体而言，骨不连发生率为26%，深部感染率为7%，骨筋膜室综合征发生率为7%。第2组骨折患者仅有44%恢复到完全功能。流行病学分析表明，胫骨近端骨折在严重程度上更接近粉碎性骨折和节段性骨折，而非中1/3和远1/3骨折。根据我们的研究结果，建议采用加压钢板固定或闭合外固定治疗。
