SchatzkerⅡ型胫骨平台骨折外侧半月板损伤类型及其与外侧平台CT表现的相关性

Analysis of the types of lateral meniscal injury in Schatzker type II tibial plateau fractures and its correlation with CT features of lateral plateau

目的探讨SchatzkerⅡ型胫骨平台骨折外侧半月板损伤的类型及其与外侧平台CT表现的相关性。方法回顾性分析2014年8月至2021年6月收治的213例SchatzkerⅡ型胫骨平台骨折患者资料,男132例、女81例;年龄29~61岁,平均44.9岁。所有患者均行切开复位内固定治疗骨折,并常规行关节镜探查以发现并处理软组织损伤。术中明确外侧半月板损伤的类型、位置,将患者分为半月板损伤组和无半月板损伤组。通过测量CT上胫骨外侧平台塌陷值(lateral plateau depression,LPD)及增宽值(lateral plateau widening,LPW),分析其与外侧半月板损伤的相关性。绘制相关的受试者工作特征(receiver operator characteristic,ROC)曲线并计算曲线下面积,确定LPD和LPW预测外侧半月板损伤的最佳临界点。结果半月板损伤组109例,主要表现为外侧半月板体部及后角损伤(98.2%,107/109),LPD为(13.1±3.2)mm;无半月板损伤组104例,LPD为(9.1±3.0)mm,差异有统计学意义(t=3.98,P<0.001);半月板损伤组和无损伤组的LPW分别为(8.0±1.3)mm和(6.7±1.6)mm,差异有统计学意义(t=2.68,P=0.011)。LPD的最佳预测临界点为7.6 mm(灵敏度为90.3%,特异度为64.7%,曲线下面积为0.834);LPW的最佳预测临界点为7.3 mm(灵敏度为80.5%,特异度为58.8%,曲线下面积为0.722)。结论SchatzkerⅡ型胫骨平台骨折合并外侧半月板损伤常表现为外侧半月板-关节囊分离、破裂和纵裂,其冠状面CT外侧平台塌陷超过7.6 mm和(或)外侧平台增宽超过7.3 mm时,易出现外侧半月板体部和(或)后角损伤。

Objective To investigate the specific types of lateral meniscus injury in Schatzker type II tibial plateau fractures and its potential correlation with CT features of the lateral plateau.Methods The data of 213 patients with Schatzker II tibial plateau fractures from August 2014 to June 2021 were retrospectively analyzed,including 132 males and 81 females,aged from 29 to 61 years,with an average of 44.9 years.All patients underwent arthroscopic evaluation of fracture reduction immediately after open reduction and internal fixation(ORIF).According to the actual situation during the operation,the types and locations of lateral meniscus injury were determined and the patients were divided into the meniscus injury group and non-injury group.By measuring lateral plateau depression(LPD)and lateral plateau widening(LPW)of the lateral tibial plateau on CT images,the correlation of which and lateral meniscus injury was analyzed.The optimal critical values of LPD and LPW for predicting lateral meniscus injury were obtained by drawing the relevant receiver operating characteristic(ROC)curves.Results The meniscus injury group(109 patients)mainly showed injuries involving the mid-body and posterior horn of lateral meniscus(98.2%,107/109)and LPD was 13.1±3.2 mm;while the LPD of 104 patients without meniscus injury was 9.1±3.0 mm with a statistical difference(t=3.98,P<0.001).The LPW of meniscus injury group and non-injury groups was 8.0±1.3 mm and 6.7±1.6 mm,respectively,and the difference was statistically significant(t=2.68,P=0.011).The optimal predictive critical point of LPD and LPW was 7.6 mm(sensitivity 90.3%,specificity 64.7%,area under the curve 0.834)and 7.3 mm(sensitivity 80.5%,specificity 58.8%,area under the curve 0.722).Conclusion Schatzker II tibial plateau fractures combined with lateral meniscus injury is usually characterized by meniscus-joint capsule separation,rupture and longitudinal fracture.The mid-body and posterior horn of lateral meniscus injury is more likely to occur when LPD>7.6 mm and/or LPW>7.3 mm on coronal CT images.