背景:胫骨后肌腱(TPT)是唯一遇到胫骨远端的肌腱,因此在胫骨远端骨折中受伤的风险最大。尽管很少有TPT受伤的报道,脚踝周围受伤,他们经常被错过和迟到。
目的:我们的目的是分析累及胫骨后骨折的TPT截留率,即Pilon(PLM)和后踝骨折(PMF)。
方法:对PMF和Pilon骨折进行了8年的回顾性分析。使用我们前瞻性收集的数据库,从2014年到2022年确定了接受手术固定其PMF或PLM的患者。包括任何经过术前CT检查的骨折。术前CT成像分析用于识别TPT截留,如果在骨折部位存在<50%的肌腱横截面,这被表示为轻微截留,如果在骨折部位存在≥50%的肌腱,则被表示为严重截留.
结果:共确定363例患者进行进一步分析,220人患有PMF,143人患有PLM损伤。TPT截留的发生率为22%(n=79),其中有64个次要和15个主要截留。如果断裂线进入TPT护套,与未进入鞘管的骨折的3.7%(7/190)相比,截留率为45%(72/172)(p<.001)。与PML相比,PMF中的TPT截留没有显着差异(p=0.353)。
结论:在我们的评估中,我们发现,在累及胫骨后段的骨折中,有22%的TPT卡压发生率.PMF和PLF在TPT截留率方面差异无统计学意义。此外,我们发现,当CT图像显示骨折线进入腱鞘时,存在TPT截留的显著风险.我们建议外科医生考虑仔细评估术前成像,以寻求识别TPT并评估术中发生诱捕的位置。
BACKGROUND: The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late.
OBJECTIVE: Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF).
METHODS: A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major.
RESULTS: A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353).
CONCLUSIONS: In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.