Segond骨折及其合并癥的外科治療_《中國修復重建外科雜志》

作者：

趙波 ¹ , 冉霞 ² , 張銘華 ¹ , 何超 ¹ , 蔣電明 ³

重慶醫科大學附屬永川醫院（重慶永川，402160）1骨科，2腎內科;;
3重慶醫科大學附屬第一醫院骨科;

關鍵詞：

Segond骨折前交叉韌帶損傷側副韌帶損傷半月板損傷關節鏡

DOI：

10.7507/1002-1892.20130228

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目的探討Segond骨折及其合并癥的致傷機制、臨床特點和治療方法。方法2007年1月－2011年12月，收治15例Segond骨折患者。男10例，女5例；年齡16～50歲，平均31.8歲。致傷原因：交通事故傷8例，運動傷6例，重物砸傷1例。術前膝關節活動度（36.60 ± 8.94）°，膝關節功能Lysholm評分為（32.27 ± 3.73）分，國際膝關節文獻委員會（IKDC）評分為（42.34 ± 4.97）分。受傷至手術時間1～3周，平均1.2周。合并前交叉韌帶體部撕裂12例，行關節鏡下同種異體脛前肌腱移植重建術；2例脛骨髁間棘撕脫骨折，行關節鏡下骨折復位Orthocord線捆綁固定術。合并半月板損傷8例，3例行半月板縫合術，5例行半月板成形術。合并側副韌帶損傷7例，5例行保守治療，2例行切開內側副韌帶可吸收線縫合修補術。所有Segond骨折塊均未處理。結果術后患者切口均Ⅰ期愈合，無切口感染及神經、血管損傷等早期并發癥發生。15例均獲隨訪，隨訪時間12～16個月，平均 14.3個月。術后12個月，患者膝關節前抽屜試驗、Lachman試驗、側方應力試驗均為陰性。膝關節活動度為（129.27 ± 5.89）°；Lysholm評分和IKDC評分均明顯提高，分別達（87.87 ± 4.12）分和（89.45 ± 3.05）分；與術前比較差異均有統計學意義（P lt; 0.05）。結論Segond骨折常伴前交叉韌帶、側副韌帶及半月板損傷，其對膝關節內聯合損傷具有提示作用，應根據具體損傷情況選擇個體化治療方案。

引用本文： 趙波,冉霞,張銘華,何超,蔣電明. Segond骨折及其合并癥的外科治療. 中國修復重建外科雜志, 2013, 27(9): 1045-1049. doi: 10.7507/1002-1892.20130228 復制

1.	Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology, 1986, 159(2): 467-469.
2.	Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol, 1988, 151(6): 1163-1167.
3.	Abdalla FH, Tehranzadeh J, Horton JA. Avulsion of lateral tibial condyle in skiing. Am J Sports Med, 1982, 10(6): 368-370.
4.	Campos JC, Chung CB, Lektrakul N, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology, 2001, 219(2): 381-386.
5.	Hess T, Rupp S, Hopf T, et al. Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res, 1994, (303): 193-197.
6.	王琪, 劉憲民, 劉松波, 等. Segond骨折合并前交叉韌帶損傷的外科治療. 中華創傷雜志, 2012, 28(8): 726-729.
7.	黃建明, 沈鋒, 眭杰, 等. Segond骨折的臨床特點與治療策略. 中國骨與關節損傷雜志, 2011, 26(6): 509-511.
8.	Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. AJR Am J Roentgenol, 2011, 197(6): W1101-1104.
9.	Sferopoulos NK, Rafailidis D, Traios S, et al. Avulsion fractures of the lateral tibial condyle in children. Injury, 2006, 37(1): 57-60.
10.	Arneja SS, Furey MJ, Alvarez CM, et al. Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population. Sports Health, 2010, 2(5): 437-439.
11.	DeLee JC, Curtis R. Anterior cruciate ligament insufficiency in children. Clin Orthop Relat Res, 1983, (172): 112-118.
12.	Pieter AM. Tibial plateau and spine fractures//McGinty JB. Operative Arthroscopy. 2nd ed. Philadelphia: Lippincott-Raven, 1996: 589-590.
13.	Arnoczky SP, Rubin RM, Marshall JL. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. J Bone Joint Surg (Am), 1979, 61(8): 1221-1229.
14.	Falciglia F, Mastantuoni G, Guzzanti V. Segond fracture with anterior cruciate ligament tear in an adolescent. J Orthop Traumatol, 2008, 9(3): 167-169.
15.	洪雷, 馮華, 耿向蘇, 等. Segond骨折與前交叉韌帶損傷相關性的臨床研究. 中華外科雜志, 2007, 45(2): 94-95.
16.	Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2): 105-110.
17.	Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
18.	Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
19.	Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med, 1979, 7(1): 27-33.
20.	Tei K, Kubo S, Matsumoto T, et al. Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 252-255.

1. Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology, 1986, 159(2): 467-469.
2. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol, 1988, 151(6): 1163-1167.
3. Abdalla FH, Tehranzadeh J, Horton JA. Avulsion of lateral tibial condyle in skiing. Am J Sports Med, 1982, 10(6): 368-370.
4. Campos JC, Chung CB, Lektrakul N, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology, 2001, 219(2): 381-386.
5. Hess T, Rupp S, Hopf T, et al. Lateral tibial avulsion fractures and disruptions to the anterior cruciate ligament. A clinical study of their incidence and correlation. Clin Orthop Relat Res, 1994, (303): 193-197.
6. 王琪, 劉憲民, 劉松波, 等. Segond骨折合并前交叉韌帶損傷的外科治療. 中華創傷雜志, 2012, 28(8): 726-729.
7. 黃建明, 沈鋒, 眭杰, 等. Segond骨折的臨床特點與治療策略. 中國骨與關節損傷雜志, 2011, 26(6): 509-511.
8. Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. AJR Am J Roentgenol, 2011, 197(6): W1101-1104.
9. Sferopoulos NK, Rafailidis D, Traios S, et al. Avulsion fractures of the lateral tibial condyle in children. Injury, 2006, 37(1): 57-60.
10. Arneja SS, Furey MJ, Alvarez CM, et al. Segond fractures: not necessarily pathognemonic of anterior cruciate ligament injury in the pediatric population. Sports Health, 2010, 2(5): 437-439.
11. DeLee JC, Curtis R. Anterior cruciate ligament insufficiency in children. Clin Orthop Relat Res, 1983, (172): 112-118.
12. Pieter AM. Tibial plateau and spine fractures//McGinty JB. Operative Arthroscopy. 2nd ed. Philadelphia: Lippincott-Raven, 1996: 589-590.
13. Arnoczky SP, Rubin RM, Marshall JL. Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs. J Bone Joint Surg (Am), 1979, 61(8): 1221-1229.
14. Falciglia F, Mastantuoni G, Guzzanti V. Segond fracture with anterior cruciate ligament tear in an adolescent. J Orthop Traumatol, 2008, 9(3): 167-169.
15. 洪雷, 馮華, 耿向蘇, 等. Segond骨折與前交叉韌帶損傷相關性的臨床研究. 中華外科雜志, 2007, 45(2): 94-95.
16. Edson CJ. Conservative and postoperative rehabilitation of isolated and combined injuries of the medial collateral ligament. Sports Med Arthrosc, 2006, 14(2): 105-110.
17. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
18. Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
19. Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med, 1979, 7(1): 27-33.
20. Tei K, Kubo S, Matsumoto T, et al. Combined osteochondral fracture of the posterolateral tibial plateau and Segond fracture with anterior cruciate ligament injury in a skeletally immature patient. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 252-255.

《中國修復重建外科雜志》

Segond骨折及其合并癥的外科治療

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《中國修復重建外科雜志》

Segond骨折及其合并癥的外科治療

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