胫骨螺旋形骨折合并后踝骨折的临床流行病学分析

目的 探讨胫骨螺旋形骨折合并后踝骨折的临床流行病学特征.方法 回顾性调查1685例成人胫腓骨骨干骨折,对其性别、年龄构成、骨折类型等情况进行分析,并对胫骨螺旋形骨折合并后踝骨折这种有规律的特殊类型骨折的致伤原因、损伤机制等进行深入研究.结果 胫腓骨骨干骨折病人男女比例4.5:1,31～40岁年龄段人数最多,占26.0%,A型骨折居多,占57.7%.胫骨螺旋形骨折病人男女比例3.0:1,41～50岁年龄层人数最多,占32.6%.胫骨螺旋形骨折合并后踝骨折占胫骨螺旋形骨折的9.7%(28/288),占全部胫腓骨骨干骨折的1.7%(28/1685),男女比例6.0:1(24/4),41～50岁年龄层人数最多,占50%(9/18),放射科漏诊率67.9%(19/28),临床骨科医师漏诊率53.6%(15/28).结论 胫骨螺旋形骨折合并后踝骨折足一种特殊类型骨折,发生率较高.胫骨螺旋形骨折合并后踝骨折是低能量损伤所致而非医源性损伤.胫骨螺旋形骨折合并后踝骨折漏诊率高,临床工作中应予以高度重视.

Clinical epidemiological analysis of adult spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture

Objective To investigate the clinical epidemiological features of adult spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture, a special kind of fracture. Methods The clinical data of 1685 cases of adult tibial and fibular shaft fracture were analyzed retrospectively. The cause and mechanism of spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture were studied in detail. Results The male and female ratio in adult tibial and fibular shaft fracture was 4. 52: 1. Most of adult tibial and fibular shaft fracture occurred in the persons aged 31 -40 (26. 0% ) and type A fracture accounted for 57.7% of the cases. The male and female ratio in adult spiral tibiul fracture was 2. 95: 1. Most of the adult spiral tibial fracture occurred in those aged 41 -50 (32. 6% ). With a male and female ratio of 6:1 (24:4) and mostly occurring in the persons aged 41 -50, spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture composed 9. 7% (28/288) of total tibial fractures and 1.7% (28/1685) of total spiral tibial and fibular fractures. Missed diagnosis rate of spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture was 67.9% (19/28) in the Department of Radiology and 53.6% in the Department of Orthopedics. Conclusion With a high incidence, spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture was caused by a low energy but not an iatrogenic damage. With a high rate of missed diagnosis, the spiral tibial shaft fracture associated with ipsilateral posterior malleolar fracture should be paid more attention to clinically.