应力分散角和SchatzkerⅡ、Ⅲ型胫骨平台骨折的相关性研究

Relationship between stress dispersion angle and Schatzker type Ⅱ and Ⅲ tibial plateau fractures

背景单纯通过X线诊断SchatzkerⅢ型胫骨平台骨折易发生漏诊,我们定义了一个新的角度(应力分散角)并探索了这个角度和SchatzkerⅡ、Ⅲ型骨折的相关性以求帮助减少SchatzkerⅢ型胫骨平台骨折的漏诊。方法回顾性分析河北医科大学第三医院2015年12月至2022年10月收治的符合纳入标准的胫骨平台骨折患者145例(SchatzkerⅡ型105例,SchatzkerⅢ型40例),SchatzkerⅡ型组男51例,女54例,平均年龄(46.08±1.53)岁;SchatzkerⅢ型组男21例,女19例,平均年龄(50.10±2.09)岁。定义胫骨中线和胫骨平台外侧缘切线之间的角度为应力分散角,通过X线测量应力分散角。统计比较SchatzkerⅡ型组和SchatzkerⅢ型组的性别、年龄、BMI、术前合并症、致伤原因、应力分散角的差异。应用Logistic回归分析对结果进行检验。结果SchatzkerⅢ型组的应力分散角(47.85±0.62)°大于SchatzkerⅡ型组(37.38±0.38)°,差异有统计学意义(P<0.05)。与SchatzkerⅡ型组相比,SchatzkerⅢ型组的致伤原因差异有统计学意义(P<0.05),SchatzkerⅢ型胫骨平台骨折受低能量损伤影响较大。2组在性别、年龄、BMI和术前并发症方面均无统计学意义(P>0.05)。将单因素分析中P<0.2的3个变量(年龄、致伤原因、应力分散角)与SchatzkerⅡ、Ⅲ型胫骨平台骨折进行Logistic回归分析。Logistic回归分析证明只有应力分散角是SchatzkerⅡ、Ⅲ型胫骨平台骨折的独立影响因素。结论应力分散角是SchatzkerⅢ型胫骨平台骨折的影响因素,诊治应力分散角较大的膝关节外伤患者时,建议行膝关节CT检查,避免漏诊的发生。

Background Diagnosis of Schatzker typeⅢtibial plateau fractures by X-ray alone is prone to underdiagnosis,we defined a new angle(stress dispersion angle)and explored the correlation be-tween this angle and Schatzker typeⅡandⅢfractures to help reduce underdiagnosis of Schatzker typeⅢtibial plateau fractures.Methods Retrospective analysis of 145 patients with tibial plateau fractures(105 cases of Schatzker typeⅡand 40 cases of Schatzker typeⅢ)admitted to the Third Hospital of Hebei Medi-cal University from December 2015 to October 2022 who met the inclusion criteria,51 men and 54 women in the Schatzker typeⅡgroup,with a mean age of 46.08 years;In the Schatzker typeⅢgroup,there were 21 males and 19 females,with an average age of 50.10 years.The angle between the midline of the tibia and the tangent line of the lateral margin of the tibial plateau was defined as the stress dispersion angle,and the stress dispersion angle was measured by X-ray.The differences in gender,age,BMI,preoperative comorbidi-ties,cause of injury,and stress dispersion angle were statistically compared between the Schatzker typeⅡgroup and the Schatzker typeⅢgroup.Logistic regression analysis was applied to test the results.Results The stress dispersion angle in the Schatzker typeⅢgroup(47.85±0.62)°was greater than that in the Schatz-ker typeⅡgroup(37.38±0.38)°,and the difference was statistically significant(P<0.05).The difference in the cause of injury was statistically significant(P<0.05)in the Schatzker typeⅢgroup compared with the Schatzker typeⅡgroup,and Schatzker typeⅢtibial plateau fractures were more affected by low-energy in-juries.There was no statistically significant difference between the 2 groups in terms of gender,age,BMI,and preoperative complications(P>0.05).Logistic regression analysis was performed to correlate the 3 vari-ables(age,cause of injury,and stress dispersion angle)with Schatzker typeⅡandⅢtibial plateau fractures with P<0.2 in the univariate analysis.Logistic regression analysis demonstrated that only the stress disper-sion angle was an independent influence on Schatzker typeⅡandⅢtibial plateau fractures.Conclusion Stress dispersion angle is an influential factor in Schatzker's typeⅢtibial plateau fracture,and when treating patients with knee trauma with a large stress dispersion angle,CT of the knee is recommended to avoid the occurrence of a missed diagnosis.