合并股骨内髁撕脱骨折的胫骨平台骨折的十字类型特征研究

An imaging study of tibial plateau fractures combined with avulsion fracture of medial femoral condyle

目的探讨合并股骨内髁撕脱骨折的胫骨平台骨折的十字类型特征。方法回顾性分析2015年1月至2018年12月期间收治的16例胫骨平台骨折合并同侧股骨内髁撕脱骨折患者资料(研究组),男9例,女7例;年龄为27~78岁,平均51.5岁。骨折按Schatzker分型:Ⅰ型2例,Ⅱ型8例,Ⅲ型3例,Ⅳ型1例,Ⅴ型2例;十字类型:Ⅰe型10例,Ⅱe型1例,Ⅲe型2例,Ⅰv型3例。并将2010年1月至2015年12月期间收治的332例单纯胫骨平台骨折患者资料作为对照组。比较两组患者胫骨平台骨折十字类型的分布特征,以及研究组内e型与Ⅰv型患者的胫骨外侧平台增宽距离、胫骨平台塌陷深度、股骨内髁撕脱骨折分离程度、膝关节内侧最大间隙及胫骨平台外翻角度等。结果16例患者胫骨外侧平台增宽距离平均为7.18 mm,胫骨平台塌陷深度平均为8.74 mm,股骨内髁撕脱骨折分离程度平均为3.44 mm,膝关节内侧最大间隙平均为7.77 mm,胫骨平台外翻角度平均为87.03°。研究组与对照组患者的胫骨平台骨折十字类型分布比较差异有统计学意义(P=0.002)。研究组内13例e型骨折患者的胫骨外侧平台增宽距离[(8.49±4.26)mm]显著大于3例Ⅰv型骨折患者[(1.51±2.11)mm],差异有统计学意义(t=2.706,P=0.017)。结论合并股骨内髁撕脱骨折的胫骨平台骨折的十字类型以e型、Ⅰv型为主,胫骨外侧平台的增宽距离有助于e型与Ⅰv型之间的划分。

Objective To explore the cross classification of tibial plateau fractures combined with avulsion fracture of medial femoral condyle.Methods The 16 patients were retrospectively analysed as an observation group who had been treated at Department of Lower Limbs,Sichuan Orthopaedic Hospital for tibial plateau fracture and avulsion fracture of the medial condyle of the same femur from January 2015 to December 2018.They were 9 males and 7 females,aged from 27 to 78 years(average,51.5 years).By the Schatzker classification,there were 2 cases of typeⅠ,8 cases of typeⅡ,3 cases of typeⅢand one case of typeⅣ;by the cross classification,there were 10 cases of typeⅠe,one case of typeⅡe and 2 cases of typeⅢe and 3 cases of typeⅠv.The 332 patients were included as a control group who had been treated at the same department for simple tibial plateau fracture from January 2010 to December 2015.The imaging data of the 2 groups were compared to find out the charateristics of cross type distribution;the widened distance of the lateral tibial plateau,collapse depth of the tibial plateau,separation of avulsion fracture of medial femoral condyle,maximum clearance of the medial knee and eversion angle of the tibial plateau were investigated in the patients with cross types e andⅠv in the observation group.Results In the observation group,the widened distance of the lateral tibial plateau averaged 7.18 mm,the collapse depth of the tibial plateau 8.74 mm,the separation of avulsion fracture of medial femoral condyle 3.44 mm,the maximum clearance of the medial knee 7.77 mm,and the eversion angle of the tibial plateau 87.03°.There was a significant difference in the cross type distribution of tibial plateau fractures between the 2 groups(P=0.002).In the observation group,the average widened distance of the lateral tibial platea for the 13 type e patients(8.49±4.26 mm)was significantly larger than that for the 3 typeⅠv patients(1.51±2.11 mm)(t=2.706,P=0.017).Conclusion The cross classification of tibial plateau fractures with avulsion fracture of mediall condyle of the same femur may result mainly in types e and typeⅠv.The widened distance of lateral tibial plateau helps distinction between types e and typeⅠv.