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成人胫骨骨折概述

Author
Karl B Fields, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
严广斌, 主任医师

引言

胫骨骨折可能是由重大创伤引起的，也可能是过度使用的后果。后一种机制导致应力性骨折。成人创伤性胫骨骨折的概述将在此讨论。应力性骨折、儿童胫骨骨折以及骨折的一般评估和处理将单独讨论。 (参见“应力性骨折的概述”和“Overview of tibial fractures in children”和“骨折处理的一般原则：骨折愈合和骨折描述”和“骨折确定性处理的一般原则”和“肌肉骨骼损伤的夹板固定”)

流行病学

高能量创伤[如，机动车辆、冬季运动(如，滑雪)和自行车事故]和低能量创伤(如，跌倒、身体接触性运动、长跑以及其他耐力或重复冲击性活动)时，均可发生胫骨骨折。高能量创伤导致的损伤更可能涉及复合性和开放性胫骨骨折，以及某些特定部位的骨折，如胫骨平台骨折[1]；低能量创伤导致的损伤更常导致单纯性横形或线形胫骨骨折。开放性胫骨骨折的并发症发生率较高，而且还存在功能受限和疼痛的长期问题[2]。

在成人和儿童中，闭合性胫骨干骨折是最常见的长骨骨折。因其导致的住院超过70,000人次、门诊超过800,000人次、住院时间达500,000日以上，这可造成重大的经济后果。在老年患者中，发生了许多由单纯跌倒引起的闭合性胫骨干骨折，在那些存在严重骨质疏松的老年患者中，可发生开放性或更加复杂的骨折，常有较高的并发症发病率[3]。

在身体接触性和非身体接触性运动事件期间，可发生胫骨骨折。数项研究证实，直接、低速的击打(如，铲球和踢球)导致了约95%的与运动有关的胫骨骨折[4]。一项为期5年的回顾性研究纳入了在一个大的创伤中心就诊的244例胫骨骨折，其中24例(9.8%)发生在足球(即，英式足球)比赛期间[5]。即使骨折是由低能量创伤引起的，在约60%的病例中，可同时发生腓骨骨折。尽管如此，在运动相关性胫骨骨折患者中，发生严重并发症的不到5%，预后通常良好。

胫骨外侧和内侧撕脱性骨折，对于寻找前交叉韧带(anterior cruciate ligament, ACL)或后交叉韧带(posterior cruciate ligament, PCL)损伤可能具有诊断性意义。Segond骨折恰好发生在附着于外侧关节囊纤维的髂胫束的下方，与ACL撕裂有关。胫骨内侧近端撕脱性骨折，可能是PCL损伤的一个标志[6-9]。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2016-02-24.
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References
Top
  1. Albuquerque RP, Hara R, Prado J, et al. Epidemiological study on tibial plateau fractures at a level I trauma center. Acta Ortop Bras 2013; 21:109.
  2. Kohlprath R, Assal M, Uçkay I, et al. [Open fractures of the tibia in the adult: surgical treatment and complications]. Rev Med Suisse 2011; 7:2482, 2484.
  3. Schmidt AH, Finkemeier CG, Tornetta P 3rd. Treatment of closed tibial fractures. Instr Course Lect 2003; 52:607.
  4. Cattermole HR, Hardy JR, Gregg PJ. The footballer's fracture. Br J Sports Med 1996; 30:171.
  5. Chang WR, Kapasi Z, Daisley S, Leach WJ. Tibial shaft fractures in football players. J Orthop Surg Res 2007; 2:11.
  6. Kaneko K, Miyazaki H, Yamaguchi T. Avulsion fracture of the tibial tubercle with avulsion of the patellar ligament in an adolescent female athlete. Clin J Sport Med 2000; 10:144.
  7. Peterson CM, Gittins ME. Tibial tuberosity avulsion in an adolescent diver. Clin J Sport Med 1997; 7:141.
  8. Inoue G, Kuboyama K, Shido T. Avulsion fractures of the proximal tibial epiphysis. Br J Sports Med 1991; 25:52.
  9. Biedert RM, Friederich N, Müller W. Medial Tibial Avulsion Fragment: Corresponding Lesion to Segond's Fracture? Clin J Sport Med 1994; 4:59.
  10. Lenehan B, Fleming P, Walsh S, Kaar K. Tibial shaft fractures in amateur footballers. Br J Sports Med 2003; 37:176.
  11. Tang ZH, Kumar VP. Alendronate-associated ulnar and tibial fractures: a case report. J Orthop Surg (Hong Kong) 2011; 19:370.
  12. Muller ME, Nararin S, Koch P, et al. Comprehensive Classification of Fracture of Long Bones, Springer-Verlag, Berlin 1990.
  13. Duke Orthopaedics. Tibia fracture. In: Wheeless' Textbook of Orthopedics. http://www.wheelessonline.com/ortho/menu_for_the_tibia_tibia_frx (Accessed on March 08, 2010).
  14. Khalid M, Brannigan A, Burke T. Calf muscle wasting after tibial shaft fracture. Br J Sports Med 2006; 40:552.
  15. Rademakers MV, Kerkhoffs GM, Kager J, et al. Tibial spine fractures: a long-term follow-up study of open reduction and internal fixation. J Orthop Trauma 2009; 23:203.
  16. Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001; 15:312.
  17. Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21:5.
  18. Brinker MR, Hanus BD, Sen M, O'Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am 2013; 95:2170.
  19. Barata I, Spencer R, Suppiah A, et al. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care 2012; 28:1154.
  20. Bolandparvaz S, Moharamzadeh P, Jamali K, et al. Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED. Am J Emerg Med 2013; 31:1583.
  21. Waterbrook AL, Adhikari S, Stolz U, Adrion C. The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED. Am J Emerg Med 2013; 31:1352.