Krause Matthias, Preiss Achim, Müller Gunnar, Madert Jürgen, Fehske Kai, Neumann Mirjam V, Domnick Christoph, Raschke Michael, Südkamp Norbert, Frosch Karl-Heinz
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany; "Fracture committee" of the German Knee Society, Germany.
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany; Department of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
Injury. 2016 Nov;47(11):2551-2557. doi: 10.1016/j.injury.2016.09.014. Epub 2016 Sep 6.
Currently existing classifications of tibial plateau fractures do not help to guide surgical strategy. Recently, a segment-based mapping of the tibial plateau has been introduced in order to address fractures with a fracture-specific surgical approach. The goal of the present study was to analyze incidence and fracture specifics according to a new 10-segment classification of the tibial plateau.
A total of 242 patients with 246 affected knees were included (124 females, 118 males, mean age 51.9±16.1years). Fractures were classified according to the OTA/AO classification. Fracture pattern was analyzed with respect to a 10-segment classification based on CT imaging of the proximal tibial plateau 3cm below the articular surface.
161 Patients suffered an OTA/AO type 41-B and 85 patients an OTA/AO type 41-C tibial plateau fracture. Females had an almost seven times higher risk to suffer a fracture due to low-energy trauma (OR 6.91, 95% CI (3.52, 13.54), p<0.001) than males. In 34% of the patients with affection of the medial tibial plateau, a fracture comminution, primarily due to low-energy trauma (p<0.001), was observed. In type B fractures, the postero-latero-lateral (65.2%), the antero-latero-lateral (64.6%) and the antero-latero-central (60.9%) segment were most frequently affected. Every second type C fracture showed an unique fracture line and zone of comminution. The tibial spine was typically involved (89.4%). A typical fracture pattern of high-energy trauma demonstrated a zone of comminution of the lateral plateau and a split fracture in the medial plateau. The most frequently affected segments were the postero-latero-central (85.9%), postero-central (84.7%), and antero-latero-central (78.8%) segment.
Posterior segments were the most frequently affected in OTA/AO type B and C fractures. Acknowledging the restricted visibility of posterior segments, whose reduction and fixation is crucial for long-term success, our findings implicate the use of posterior approaches more often in the treatment of tibial plateau fractures. Also, low-energy trauma was identified as an important cause for tibial plateau fractures.
目前现有的胫骨平台骨折分类方法无助于指导手术策略。最近，为了采用针对特定骨折的手术方法来处理骨折，引入了基于节段的胫骨平台映射。本研究的目的是根据一种新的胫骨平台10节段分类法分析发病率和骨折特点。
共纳入242例患者的246个患膝（女性124例，男性118例，平均年龄51.9±16.1岁）。骨折根据OTA/AO分类法进行分类。基于胫骨近端平台关节面以下3cm处的CT成像，根据10节段分类法分析骨折类型。
161例患者发生OTA/AO 41-B型骨折，85例患者发生OTA/AO 41-C型胫骨平台骨折。女性因低能量创伤发生骨折的风险几乎是男性的7倍（OR 6.91，95%CI（3.52，13.54），p<0.001）。在34%累及胫骨内侧平台的患者中，观察到骨折粉碎，主要由于低能量创伤（p<0.001）。在B型骨折中，后外侧（65.2%）、前外侧（64.6%）和前外侧中央（60.9%）节段最常受累。每例C型骨折中，有一半显示独特的骨折线和粉碎区域。胫骨棘通常受累（89.4%）。高能量创伤的典型骨折类型表现为外侧平台粉碎区域和内侧平台劈裂骨折。最常受累的节段是后外侧中央（85.9%）、后中央（84.7%）和前外侧中央（78.8%）节段。
在OTA/AO B型和C型骨折中，后节段最常受累。鉴于后节段视野受限，而其复位和固定对长期疗效至关重要，我们的研究结果提示在胫骨平台骨折治疗中应更频繁地采用后入路。此外，低能量创伤被确定为胫骨平台骨折的一个重要原因。
