背景:创伤性胫腓骨近端骨折脱位(PTFD)的研究很少,在临床实践中很容易被遗漏。PTFD被认为是严重受伤的膝盖的标志。目的回顾性分析膝关节创伤伴血管损伤中PTFD的发生率及影响。
方法:纳入2022年1月至2023年10月的膝关节创伤和血管损伤患者。回顾性分析纳入患者的X线和CT扫描以确定PTFD的存在。进一步将患者分为PTFD组和非PTFD组进行比较分析。
结果:共纳入27例患者(28条肢体)。创伤性膝关节血管损伤的PTFD发生率为39.3%(11/28),包括8个前外侧脱位和3个后内侧脱位。与非PTFD组相比,PTFD组四肢开放性损伤明显增多(10/11VS7/17,p<0.05)。PTFD组截肢率高达40%(4/10),与非PTFD组的23.5%(4/17)相比。然而,两组间差异无统计学意义(p>0.05)。
结论:PTFD容易被忽视或错过。在患有血管损伤的膝盖中,PTFD发生率高。PTFD的存在可能表明严重的膝关节创伤和开放性损伤的可能性。虽然与非PTFD组比较无显著性差异,PTFD组的截肢率相对较高,为40%。
BACKGROUND: Traumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of severely traumatized knees. The purpose of this study was to retrospectively analyze the incidence and impact of PTFD in traumatized knees with vascular injury.
METHODS: Patients with knee trauma and vascular injury were included from January 2022 to October 2023. X-rays and CT scans of included patients were retrospectively analyzed to determine the presence of PTFD. Patients were further divided into PTFD group and non-PTFD group for further comparative analysis.
RESULTS: A total of 27 patients (28 limbs) were included. Incidence of PTFD was 39.3% (11/28) in traumatic knee with vascular injury, including 8 anterolateral dislocations and 3 posteromedial dislocations. PTFD group had significantly more limbs with open injuries compared with non-PTFD group (10/11 VS 7/17, p<0.05). Amputation rate of PTFD group was as high as 40% (4/10), compared to 23.5% (4/17) in non-PTFD group. However, the difference between two groups was not statistically significant (p>0.05).
CONCLUSIONS: PTFD was easily overlooked or missed. In traumatized knees with vascular injury, incidence of PTFD was high. The presence of PTFD might indicate severe knee trauma and the possibility of open injury. Although there was no significant difference compared with non-PTFD group, PTFD group had a relatively high amputation rate of 40%.