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成人胫骨干骨折

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

引言

胫骨骨折是常见的长骨损伤。美国国家卫生统计中心引述美国每年有492,000例胫骨骨折。开放性骨折一般发生于高速创伤时(如，机动车碰撞)。闭合性损伤可发生于跌倒或运动相关创伤时。

本专题将总结胫骨干骨折相关内容。儿童胫骨干骨折和成人胫骨骨折总体概述参见其他专题。 (参见“儿童的胫腓骨干骨折”和“成人胫骨骨折概述”)

流行病学

美国每年因胫骨干骨折造成超过70,000次住院、800,000次就诊和500,000日住院[1]。对于并发症发病率和死亡率较高相关的复合性或更复杂性骨折，存在严重骨质疏松会增加其风险[2,3]。更严重的胫骨骨折源于高能量创伤，最常见于机动车碰撞[2,4,5]。在欧洲，闭合性胫骨骨折常与足球(英式足球)相关[6,7]。护腿板可能提供一些保护，但遭受胫骨骨折的许多球员在受伤时佩戴了护腿板[8]。滑雪是另一种常与低能量(往往是扭转性)胫骨骨折相关的运动[2]。

临床解剖学

胫骨是小腿的主要负重骨(图片 1和图片 2)。胫骨的近端部分(即，胫骨平台)构成膝关节的下表面(图 1和图片 3)。胫骨干连接胫骨平台与胫骨远端；胫骨远端由胫距关节处踝关节的上关节面和内踝构成。胫骨粗隆是另一个关键的骨性标志，位于膝关节线和髌骨下极下方数厘米处，是髌韧带的附着点[9]。

在胫骨和腓骨之间全长有坚韧的纤维结构连接，称为骨间膜或韧带联合(图 2)。在近端，骨间膜由坚韧的前后韧带加强，形成一个滑膜关节，称为近端胫腓关节。在远端，骨间膜和胫腓前、后、横韧带这3条韧带共同稳定上部踝关节结构。

               

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-23.
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