上胫腓关节脱位合并胫骨干骨折一例报告

Superior tibiofibular dislocation with tibial shaft fracture: 1 case report

临床资料上胫腓关节是由腓骨头胫骨关节面和胫骨外侧髁腓骨关节面组成的小关节,周围有较为强韧的支持韧带。Nelaton 于 1874 年首次报道了上胫腓关节脱位[1],之后有部分病例报道。上胫腓关节脱位是一种较为罕见的下肢损伤[2],常常伴随有同侧的胫骨骨折等其它损伤。因为脱位后没有特殊的临床症状,而且经常被其它严重损伤掩盖伤情,导致上胫腓关节脱位常常被忽视,临床漏诊率很高[3]。

Objective Superior tibiofibular dislocation is rare but with a high rate of miss-diagnosis.We reported a case of superior tibiofibular dislocation combined with tibial shaft fracture and give a brief review on its anatomical feature,mechanical characteristics,classification,diagnosis and treatment.Methods Terms such as "proximal tibiofibular joint" and "superior tibio-firyan joint" were used to retrieve the researches related to the dislocation of the superior tibiofibular joint published on PubMed and Medline.Results One male diagnosed as superior tibiofibular dislocation combined with tibial shaft fracture (AO classification:B 2.1) underwent limited open reduction and intramedullary fixation of the left tibia fracture + open reduction and internal fixation of the proximal tibiofibular joint + reconstruction of the left lateral collateral ligament and biceps tendon.After the operation,the patient was immobilized with the left lower limb brace for 6 weeks.Internal fixation screws of the superior tibiofibular joint were removed 8 weeks post-operation.Normal activities recovered after weight-bearing exercises and rehabilitation.A total of 100 related papers were included.Conclusions Reasons of missed diagnosed:difficulty to distinguish dislocation in the unilateral AP and lateral X-ray images of the knee;other severe concomitant injuries masked the injury of the proximal tibiofibular joint;symptoms and signs of dislocation of the superior tibiofibular joint were not special enough and tended to be missed.Axial bilateral CT image,AP and lateral X-ray image of the knee,Sijbrandi sign and Radulescu sign were recommended for the confirmation of the diagnosis.