Schatzker Ⅳ型胫骨平台骨折韧带损伤的MRI观察及对膝关节稳定性的影响

Ligamentous injuries in SchatzkerⅣtibial plateau fracture:an MRI observation and their influence on knee instability

目的使用MRI分析SchatzkerⅣ型胫骨平台骨折韧带损伤的发生率,结合CT上的骨折形态确定患者膝关节脱位的主要因素。方法回顾分析2010年1月至2019年12月江苏省人民医院创伤骨科手术治疗并有术前X线、CT和MRI的30例SchatzkerⅣ型胫骨平台骨折患者资料。男18例,女12例;年龄22~75岁,平均45.4岁。根据正位X线片判断是否发生膝关节脱位将其分为无脱位组和脱位组。在CT上根据改良胫骨平台三柱分型分析骨折的形态。在MRI上确定各主要韧带损伤的发生率。统计比较无脱位组和脱位组间骨折形态、韧带损伤发生率的差异。多元线性回归分析确定导致膝关节脱位的主要因素。结果30例患者中,脱位组12例,无脱位组18例。66.7%(20例)的患者表现为内侧柱+后内侧柱+后外侧柱损伤,脱位组中,该骨折形式占83.3%(10例)。膝关节前交叉韧带(ACL)损伤的总体发生率是96.7%(29例),后交叉韧带(PCL)损伤率为43.3%(13例),内侧副韧带(MCL)损伤率为70.0%(21例),后外侧韧带复合体(PLC)损伤率为90.0%(27例),前外侧韧带(ALL)损伤率为73.3%(22例),多韧带损伤(≥2条)的发生率为90.0%(27例)。无脱位组和脱位组后外侧柱损伤发生率分别为55.6%(10/18)和91.7%(11/12),差异有统计学意义(P<0.05),但在各单一韧带损伤和多韧带损伤的发生率方面差异无统计学意义(P>0.05)。多元线性回归分析证明后外侧柱损伤是关节脱位的危险因素(P<0.05)。结论SchatzkerⅣ型胫骨平台骨折的韧带损伤发生率很高,但胫骨平台后外侧柱骨折是导致部分患者发生膝关节脱位的主要原因。

Objective To conduct an MRI observation on the incidences of ligamentous injuries and fracture morphology in Schatzker typeⅣtibial plateau fracture(TPF)and investigate their influence on knee stability.Methods A retrospective analysis was conducted of the 30 patients with Schatzker typeⅣTPF who had undergone surgery at Department of Orthopaedic Trauma,Jiangsu Provincial People's Hospital from January 2010 to December 2019 and whose preoperative X-ray,CT and MRI were available.They were 18 males and 12 females,aged from 22 to 75 years(mean,45.4 years).They were divided into a dislocation-free group and a dislocation group according to the absence or presence of knee dislocation on their anteroposterior X-ray films.The fracture morphology was assessed on CT according to the modified three-column classification.The incidences of ligamentous injuries[involving anterior cruciate ligament(ACL),posterior cruciate ligament(PCL),medial collateral ligament(MCL),posterolateral complex(PLC)and anterolateral ligament(ALL)]were investigated on MRI.The 2 groups were compared in fracture morphology and incidences of ligamentous injuries.Multiple linear regression(MLR)analysis was used to identify the main factor contributing to preoperative knee dislocation.Results The dislocation group had 12 patients and the dislocation-free group 18.The fracture involving medial+posteromedial+posterolateral columns was found in 66.7%of the patients(20 cases),and accounted for 83.3%(10 cases)in the dislocation group.The incidence was 96.7%(29 cases)for ACL injury,43.3%(13 cases)for PCL injury,70.0%(21 cases)for MCL injury,90%(27 cases)for PLC injury,73.3%(22 cases)for ALL injury and 90%(27 cases)for the multiple-ligament disruption.There was a significant difference in the posterolateral column injury between the dislocation-free group[55.6%(10/18)]and the dislocation group[91.7%(11/12)](P<0.05),but there were no significant differences between the 2 group in the injury to any other single ligament or multiple ligaments(P>0.05).The MLR analysis confirmed that the posterolateral column injury was a risk factor for coronary plane dislocation in Schatzker typeⅣTPF(P<0.05).Conclusions In Schatzker typeⅣTPF,the incidences of ligamentous injuries are very high but the fracture of posterolateral column may be the main cause for preoperative knee dislocation in some patients.