Stannard James P, Lopez Robert, Volgas David
Department of Orthopaedic Surgery, University of Missouri Hospital, Columbia, Missouri 65201, USA.
J Knee Surg. 2010 Dec;23(4):187-92. doi: 10.1055/s-0030-1268694.
The purpose of this study was to document the pattern of ligament and meniscal injuries that occur during high-energy tibial plateau fractures. One hundred three patients with fractures due to high-energy mechanisms were evaluated with knee magnetic resonance imaging (MRI). All studies were read by a single musculoskeletal radiologist who was blinded to surgical and physical exam findings. Pertinent demographic information was obtained. There were 66 patients with AO/OTA type 41C fractures and 37 patients with AO/OTA type 41B fractures. Seventy-three (71%) patients tore at least one major ligament group, and 55 (53%) patients tore multiple ligaments. There were 53 torn ligaments in AO/OTA type 41C fractures (80%) compared with 20 torn ligaments in AO/OTA type 41B fractures (54%) (p < 0.001, Fisher's exact test). Using Schatzker's classification, we found the following correlation: type I, 13 fractures with 6 ligaments (46%); type II, 11 fractures with 5 ligaments (45%); type IV, 13 fractures with 9 ligaments (69%); type V, 13 fractures with 11 ligaments (85%); and type VI, 53 fractures with 42 ligaments (79%). A significant difference exists between the groups regarding the incidence of ligament injuries (p < 0.05) and also regarding high-energy (type IV, V, VI) versus low-energy (type I, II, III) fracture patterns. The incidence of knee dislocation was 32% for AO/OTA type 41B fractures and 23% for AO/OTA type 41C fractures. Knee dislocations (dislocated on presentation, bicruciate injury, or at least three ligament groups torn with a dislocatable knee) were most common in Schatzker type IV fractures (46%). Fifty patients sustained meniscus tears (49%), with 25 medial menisci and 35 lateral menisci injuries. Tibial plateau fractures frequently have important soft tissue injuries that are difficult to diagnose on physical examination. High-energy fracture patterns (AO/OTA type 41C or Schatzker type IV, V, VI) clearly have a significantly higher incidence of ligament injury, and these patients should be carefully evaluated to rule out a spontaneously reduced knee dislocation. We believe MRI scanning should be considered for tibial plateau fractures due to high-energy mechanism, allowing identification and treatment of associated soft tissue injuries.
本研究的目的是记录高能胫骨平台骨折期间发生的韧带和半月板损伤模式。对103例因高能机制导致骨折的患者进行了膝关节磁共振成像（MRI）评估。所有研究均由一名对手术和体格检查结果不知情的肌肉骨骼放射科医生解读。获取了相关的人口统计学信息。有66例AO/OTA 41C型骨折患者和37例AO/OTA 41B型骨折患者。73例（71%）患者至少撕裂了一组主要韧带，55例（53%）患者撕裂了多条韧带。AO/OTA 41C型骨折中有53条韧带撕裂（80%），而AO/OTA 41B型骨折中有20条韧带撕裂（54%）（p<0.001，Fisher精确检验）。使用Schatzker分类法，我们发现了以下相关性：I型，13例骨折，6条韧带撕裂（46%）；II型，11例骨折，5条韧带撕裂（45%）；IV型，13例骨折，9条韧带撕裂（69%）；V型，13例骨折，11条韧带撕裂（85%）；VI型，53例骨折，42条韧带撕裂（79%）。各亚组之间在韧带损伤发生率方面存在显著差异（p<0.05），在高能（IV型、V型、VI型）与低能（I型、II型、III型）骨折模式方面也存在显著差异。AO/OTA 41B型骨折的膝关节脱位发生率为32%，AO/OTA 41C型骨折为23%。膝关节脱位（就诊时脱位、双交叉韧带损伤或至少三组韧带撕裂且膝关节可脱位）在Schatzker IV型骨折中最为常见（46%）。50例患者发生半月板撕裂（49%），其中内侧半月板损伤25例，外侧半月板损伤35例。胫骨平台骨折常伴有重要的软组织损伤，体格检查时难以诊断。高能骨折模式（AO/OTA 41C型或Schatzker IV型、V型、VI型）的韧带损伤发生率明显更高，应对这些患者进行仔细评估，以排除自发复位的膝关节脱位。我们认为，对于因高能机制导致的胫骨平台骨折，应考虑进行MRI扫描，以便识别和治疗相关的软组织损伤。
