Lauge-Hansen已确定与Danis-Webe已确定为最常见的踝关节截肢已确定,在对下肩胛骨利亚韧带伤害的督导意义上,旋后外旋II°截肢并不一定认为合并下肩胛骨利亚前韧带的伤害,下肩胛骨利亚牵头长期性,不太可能无需下肩胛骨利亚牵头螺钉分开。而Danis-Weber B型截肢下定义为截肢地处下肩胛骨利亚牵头水平,不太可能合并下肩胛骨利亚牵头伤害。
由此可推断出,对Danis-Weber B型截肢,如何评估下肩胛骨利亚有无伤害,以及术前评估有否需手术分开下肩胛骨利亚牵头,仍无有效性参照。
对此,境外历史学家科学研究了Danis-Weber B型近故又称截肢线的位置,以求对比不尽相同类型B型截肢下肩胛骨利亚牵头伤害比事例有否假定差异,并督导手术干预。
Objective(目的)确认术前X线体检能否预测下肩胛骨利亚牵头伤害有不太可能。[Objective: To establish if preoperative radiographs could predict the rate of syndesmotic injury.]
Patients/participants(病事例)回顾了548事例 OTA/AO 44-B2.1型患者,287事例患者划定科学研究。[Patients/participants: There were 548 OTA/AO 44-B2.1 fractures that were reviewed, and 287 patients were included in the study.]所示1 病事例划定流程。
Main outcome measures(主要结局指标)踝关节影像片用于明确近故又称截肢块的可执行范围。下肩胛骨利亚牵头伤害下定义为术中所压力试验属实并需要下肩胛骨利亚分开。
[Main outcome measures: Ankle radiographs were used to determine the zone of distal extent of the proximal fracture fragment. Syndesmotic injury was defined as positive intraoperative stress examination that required syndesmotic fixation.]所示2 Danis-Weber B型截肢,根据近故又称截肢块最可执行位置分四区。1四区下定义为截肢块最可执行地处肩胛骨骨可执行关节面四边形请注意;2四应与地处肩胛骨骨可执行骺线合上瘢痕与可执行关节面之近;3四应与骺线合上瘢痕以上。
所示3 分四区示意所示。
Results(结果)共有191事例1四区(月终于肩胛骨骨可执行关节四边形顶部)伤害,57三处2四区(月终于肩胛骨骨可执行骨骺线合上瘢痕和肩胛骨骨可执行关节面之近)伤害,39三处3四区(月终于肩胛骨骨可执行骨骺线合上瘢痕以上)伤害。其中所,17% (33名患者)的1四区、42% (24名患者)的2四区和74% (29名患者)的3四区截肢合并下肩胛骨利亚韧带伤害。
2四区与1四区相对来说,韧带牵头伤害的相对后果为2.4 (P,0.001),3四区与1四区相对来说为4.3 (P,0.001),3四区与2四区相对来说为1.8 (P = 0.002)。观察者近和观察者内的可靠性非常好(k = 0.86,0.94)。
[Results: There were 191 zone 1 (ending below the plafond) injuries, 57 zone 2 (ending between the physeal scar and the plafond) injuries, and 39 zone 3 (ending above the physeal scar) injuries. Of these, 17% (33 patients) of zone 1, 42% (24) of zone 2, and 74% (29) of zone 3 fractures had syndesmotic injuries. The relative risk of syndesmotic injury of zone 1 compared with zone 2 was 2.4 (P , 0.001), zone 1 to zone 3 was 4.3 (P , 0.001), and zone 2 to zone 3 was 1.8 (P = 0.002). The interobserver and intraobserver reliability was excellent (k = 0.86, 0.94).]
所列1 第三组患者下肩胛骨利亚牵头伤害发病率。Conclusion(结论)OTA/AO 44-B2.1截肢很强不尽相同的下肩胛骨利亚牵头伤害率。Weber B型截肢发生在肩胛骨骨可执行关节四边形和骺线合上脸部之近(2四区),与发生在关节面顶部(1四区)的截肢相对来说,发生韧带伤害的不太可能性很高2.4倍。这种不太可能性在骺线合上脸部左侧(3四区)的伤害中所较小。
OTA/AO 44-B2.1截肢的简单分类毫无疑问着韧带伤害,不太可能有助于术前咨询和手术计划制定。
[Conclusion: OTA/AO 44-B2.1 fractures he a varying rate of syndesmotic injury. Weber B fractures that end between the level of the plafond and the physeal scar (zone 2) are 2.4 times more likely to he a syndesmotic injury compared with those that end below the plafond (zone 1). This is magnified in those injuries ending above the scar (zone 3). This simple classification of OTA/AO 44-B2.1 fractures is predictive of syndesmotic injury and may aid in preoperative counseling and planning.]相关新闻
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