Segond骨折及其合并症的外科治疗_《中国修复重建外科杂志》

作者：

赵波 ¹ , 冉霞 ² , 张铭华 ¹ , 何超 ¹ , 蒋电明 ³

重庆医科大学附属永川医院（重庆永川，402160）1骨科，2肾内科;;
3重庆医科大学附属第一医院骨科;

关键词：

Segond骨折前交叉韧带损伤侧副韧带损伤半月板损伤关节镜

DOI：

10.7507/1002-1892.20130228

视频：

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目的探讨Segond骨折及其合并症的致伤机制、临床特点和治疗方法。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；年龄16～50岁，平均31.8岁。致伤原因：交通事故伤8例，运动伤6例，重物砸伤1例。术前膝关节活动度（36.60 ± 8.94）°，膝关节功能Lysholm评分为（32.27 ± 3.73）分，国际膝关节文献委员会（IKDC）评分为（42.34 ± 4.97）分。受伤至手术时间1～3周，平均1.2周。合并前交叉韧带体部撕裂12例，行关节镜下同种异体胫前肌腱移植重建术；2例胫骨髁间棘撕脱骨折，行关节镜下骨折复位Orthocord线捆绑固定术。合并半月板损伤8例，3例行半月板缝合术，5例行半月板成形术。合并侧副韧带损伤7例，5例行保守治疗，2例行切开内侧副韧带可吸收线缝合修补术。所有Segond骨折块均未处理。结果术后患者切口均Ⅰ期愈合，无切口感染及神经、血管损伤等早期并发症发生。15例均获随访，随访时间12～16个月，平均 14.3个月。术后12个月，患者膝关节前抽屉试验、Lachman试验、侧方应力试验均为阴性。膝关节活动度为（129.27 ± 5.89）°；Lysholm评分和IKDC评分均明显提高，分别达（87.87 ± 4.12）分和（89.45 ± 3.05）分；与术前比较差异均有统计学意义（P lt; 0.05）。结论Segond骨折常伴前交叉韧带、侧副韧带及半月板损伤，其对膝关节内联合损伤具有提示作用，应根据具体损伤情况选择个体化治疗方案。

引用本文： 赵波,冉霞,张铭华,何超,蒋电明. Segond骨折及其合并症的外科治疗. 中国修复重建外科杂志, 2013, 27(9): 1045-1049. doi: 10.7507/1002-1892.20130228 复制

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, 刘宪民, 刘松波, 等. Segond骨折合并前交叉韧带损伤的外科治疗. 中华创伤杂志, 2012, 28(8): 726-729.
7.	黄建明, 沈锋, 眭杰, 等. Segond骨折的临床特点与治疗策略. 中国骨与关节损伤杂志, 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, 冯华, 耿向苏, 等. Segond骨折与前交叉韧带损伤相关性的临床研究. 中华外科杂志, 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, 刘宪民, 刘松波, 等. Segond骨折合并前交叉韧带损伤的外科治疗. 中华创伤杂志, 2012, 28(8): 726-729.
7. 黄建明, 沈锋, 眭杰, 等. Segond骨折的临床特点与治疗策略. 中国骨与关节损伤杂志, 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, 冯华, 耿向苏, 等. Segond骨折与前交叉韧带损伤相关性的临床研究. 中华外科杂志, 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.

《中国修复重建外科杂志》

Segond骨折及其合并症的外科治疗

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《中国修复重建外科杂志》

Segond骨折及其合并症的外科治疗

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