Orthopaedic Trauma Service, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, MO 63110, USA.
J Orthop Trauma. 2011 Sep;25(9):560-5. doi: 10.1097/BOT.0b013e318200971d.
To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures.
Retrospective radiographic review.
Two Level I trauma centers.
Sagittal inclination of the medial and lateral plateau measured in relation to the longitudinal axis of the tibia using computed tomographic reconstruction images.
Seventy-four patients (mean age, 49 years; range, 16-82 years; 64% male) with acute bicondylar tibial plateau fractures (Orthopaedic Trauma Association 41C, Schatzker VI) treated from October 2006 to July 2009.
The average sagittal plane angulation of the lateral plateau was 9.8° posteriorly (range, 17° anteriorly to 37° posteriorly). The medial plateau was angulated 4.1° posteriorly on average (range, 16° anteriorly to 31° posteriorly). Forty-two lateral plateaus were angulated more than 5° from the "normal" anatomic slope (defined as 5° of posterior tibial slope). Of these, 76% were angulated posteriorly. Forty-three (58%) of the medial plateaus were angulated greater than 5° from normal, of which only 47% were inclined posteriorly (P = 0.019 compared with lateral plateaus). In 68% of patients, the difference between medial and lateral plateaus was greater than 5°; the average intercondylar slope difference was 9° (range, 0°-31°; P < 0.001). Spanning external fixation did not affect the slope of either the medial or lateral tibial plateau. Intraobserver and interobserver correlations were high for both the medial and lateral plateaus (r > 0.81, P < 0.01).
Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.
评估双髁胫骨平台骨折矢状面畸形的发生率和严重程度。
回顾性影像学研究。
两个一级创伤中心。
使用 CT 重建图像，测量胫骨内侧和外侧平台矢状倾斜度与胫骨长轴的关系。
74 例（平均年龄 49 岁；范围 16~82 岁；64%为男性）急性双髁胫骨平台骨折（OTA 41C 型，Schatzker VI 型）患者，于 2006 年 10 月至 2009 年 7 月接受治疗。
外侧平台矢状面平均向后成角 9.8°（范围 17°前向至 37°后向）。内侧平台平均向后成角 4.1°（范围 16°前向至 31°后向）。42 个外侧平台成角大于 5°（定义为 5°胫骨后倾角）偏离“正常”解剖斜率。其中 76%向后成角。43 个（58%）内侧平台成角大于 5°偏离正常，其中仅 47%向后成角（与外侧平台相比，P = 0.019）。68%的患者内外侧平台之间的差异大于 5°；平均髁间斜率差为 9°（范围 0°~31°；P < 0.001）。跨外侧固定支架不会影响内外侧胫骨平台的斜率。内侧和外侧平台的观察者内和观察者间相关性均较高（r > 0.81，P < 0.01）。
大多数双髁胫骨平台骨折存在明显的矢状面畸形。外侧平台更倾向于矢状面成角，且倾向于增加后倾斜率。大多数患者内外侧平台之间存在明显差异。这种畸形的识别有助于术前准确计划和具体复位操作，以恢复解剖对线。
