胫骨平台骨折的四柱九区分型体系

Classification of tibia plateau fracture according to the"four-column and nine-segment"

目的拟建立基于CT图像的胫骨平台骨折四柱九区分型体系,总结各区块损伤发生规律。方法回顾性分析2007年12月至2018年5月江苏大学附属人民医院骨科收治的698例(704膝)成年胫骨平台骨折患者的资料。男377例,女321例;平均年龄51.6岁。左膝371例(53.2%),右膝321例(46.0%),双侧6例(0.9%)。新分型将胫腓骨近端划分为四个柱和九个区块,定义各柱和区的损伤类型细则,并设立胫骨平台损伤指数(TPII)。使用新的分型体系回顾性分析所有骨折的CT图像,统计各区块的损伤发生率并总结分布规律。结果一柱损伤、两柱损伤、三柱损伤和四柱损伤的比例分别为30.5%(215/704)、31.5%(222/704)、28.0%(197/704)和9.9%(70/704)。所有受累的膝平均(2.2±1.0)柱损伤、(3.6±2.1)区块损伤。TPII平均为(5.7±3.0)。轻、中、重度粉碎的比例分别为50.0%(352/704)、37.5%(264/704)和12.5%(88/704)。外侧柱损伤(572,81.3%)和中间柱损伤(524,74.4%)发生率较高,内侧柱损伤(219,31.1%)和腓骨柱损伤(218,31.0%)发生率较低。最多被累及的为依次为后外侧区块(465,66.1%)、前外侧区块(453,64.3%)和后正中区块(379,53.8%),最少累及的为胫骨结节区块(85,12.1%)。结论全新的胫骨平台骨折四柱九区分型体系将有助于胫骨平台骨折的临床诊断、统计分析和预后评估。

Objective To characterize tibial plateau fractures using a computed-tomography-based"four-column and nine-segment"classification.Methods A retrospective analysis was conducted of the 698 adult patients with tibial plateau fracture(704 knees)who had been admitted to Department of Orthopedics,The Affiliated People's Hospital of Jiangsu University from December 2007 to May 2018.They were 377 males and 321 females with an average age of 51.6 years.The left knee was affected in 371 cases(53.2%),the right knee in 321 cases(46.0%)and bilateral knees in 6 cases(0.9%).According to the differentiated morphological characteristics,the tibial plateau and proximal fibula were divided into 4 columns,which were subdivided into 9 segments.Tibial plateau injury index(TPII)was innovatively introduced to represent the extent of injury.Fracture mapping was retrospectively analyzed according to the"four-column and nine-segment"classification based on the CT imaging.Results The rates of one-column,two-column,three-column and four-column injuries were 30.5%(215/704),31.5%(222/704),28.0%(197/704),and 9.9%(70/704),respectively.On average,2.2 columns±1.0 columns and 3.6 segments±2.1 segments were affected in each case.The mean TPII was 5.7±3.0.The rates of mild,moderate and severe comminuted fractures were 50.0%(352/704),37.5%(264/704),and 12.5%(88/704).The columns most frequently affected were the lateral column(572,81.3%)and the intermedial column(524,74.4%)while the less frequently involved ones the medial column(219,31.1%)and the fibular column(218,31.0%).The sequence of the segments affected was the posterolateral segment(465,66.1%),the anterolateral segment(453,64.3%),the posteromedian segment(379,53.8%)and the tubercle segment(85,12.1%).Conclusions The novel"four-column and nine-segment"classification may be a beneficial system for clinical diagnosis,statistical analysis and prognostic judgment of tibial plateau fractures.