Gardner Michael J, Yacoubian Shahan, Geller David, Pode Matthew, Mintz Douglas, Helfet David L, Lorich Dean G
Hospital for Special Surgery, New York, New York 10021, USA.
J Trauma. 2006 Feb;60(2):319-23; discussion 324. doi: 10.1097/01.ta.0000203548.50829.92.
Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI).
Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures.
When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement.
Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.
胫骨外侧平台劈裂凹陷骨折（Schatzker II型）伴有明显的关节囊韧带和半月板损伤风险。我们推测前后位（AP）平片上骨折的凹陷和增宽程度与磁共振成像（MRI）上这些结构的损伤发生率相关。
62例连续的Schatzker II型胫骨平台骨折患者术前进行了膝关节X线系列检查和MRI检查。测量AP平片上的外侧关节面凹陷和髁增宽情况，并评估MRI上膝关节周围软组织结构的损伤情况。对于每个结构，确定导致软组织损伤差异最大的凹陷和增宽阈值。应用多元逻辑回归分析来计算高于阈值的凹陷和/或增宽是否可预测单个软组织结构的损伤。
当凹陷大于6mm且增宽大于5mm时，83%的骨折发生外侧半月板损伤，而移位较小的骨折（50%）发生该损伤的比例较低（p<0.05）。当凹陷或增宽至少为8mm时，内侧半月板损伤更常见（凹陷53%，p<0.05；增宽78%，p<0.05；而两者均未达到15%）。移位极小的骨折（<4mm）未出现外侧副韧带和后交叉韧带撕裂，但随着移位增加，损伤发生率接近30%。
由于某些中心MRI设备有限，平片上测量的外侧髁凹陷和增宽与各种软组织结构损伤之间的相关性，对于规划开放或关节镜治疗方法可能非常有帮助。根据这些指导原则，凹陷或增宽接近5mm的Schatzker II型骨折在诊断和治疗这些伴随的软组织损伤时应提高警惕。
