Porrino Jack, Richardson Michael L, Hovis Keegan, Twaddle Bruce, Gee Albert
Department of Radiology, University of Washington, Seattle, WA.
Department of Radiology, University of Washington, Seattle, WA.
Curr Probl Diagn Radiol. 2018 Nov;47(6):410-416. doi: 10.1067/j.cpradiol.2017.09.001. Epub 2017 Sep 12.
We identified common morphologies of tibial plateau fractures that arise with multiligament knee injuries (MLKIs), and investigated the relationship of the fracture with ligament tears. We also evaluated the correlation of 3 tibial plateau fracture classification systems (Schatzker, AO, and Duparc).
Over a 2-year period, a single orthopaedic surgeon at our institution managed 90 MLKIs. Images of those knees with a tibial plateau fracture were retrospectively reviewed and classified per Schatzker, AO, and Duparc systems. Correlation among the 3 systems was evaluated using Spearman nonparametric correlation coefficient. Associations between fracture grading system and ligament tears were estimated using logistic regression. Associations between ligament tears and tibial plateau fracture location (medial vs lateral) were estimated using exact logistic regression.
A total of 19 of 90 knees suffered tibial plateau fractures. There was reasonable correlation among the 3 tibial plateau classification systems. Increasing grade under the Schatzker system showed statistically significant associations with medial collateral ligament (MCL) (P = 0.056) and posterolateral corner (PLC) (P = 0.035) tears. Increasing grade under the Duparc system showed statistically significant associations with MCL (P = 0.032) and PLC (P = 0.058) tears. PLC tears had a statistically significant association with medial plateau fractures (P = 0.003); odds ratio of 121.1 (95% CI: 2.2-∞). MCL tears had a statistically significant association with lateral plateau fractures (P = 0.004); odds ratio of 18.4 (95% CI: 2.1-∞). Although not statistically significant, 8 out of 9 knees with a lateral plateau fracture demonstrated tear of the anterior cruciate ligament (ACL).
As the grade of designation increases within the Schatzker and Duparc tibial plateau fracture classifications, as does the likelihood of MCL and PLC tear. The majority of tibial plateau fractures that occur in the context of MLKI are either isolated to the medial or lateral tibial plateau. Medial tibial plateau fractures are associated with PLC tears. Lateral tibial plateau fractures are associated with MCL tears, and although not statistically significant in our small sample size, 8 out of 9 knees also demonstrated a tear of the ACL.
我们确定了多韧带膝关节损伤（MLKI）时出现的胫骨平台骨折的常见形态，并研究了骨折与韧带撕裂之间的关系。我们还评估了三种胫骨平台骨折分类系统（Schatzker、AO和Duparc）的相关性。
在两年时间里，我们机构的一名骨科医生处理了90例MLKI。对那些伴有胫骨平台骨折的膝关节图像进行回顾性分析，并根据Schatzker、AO和Duparc系统进行分类。使用Spearman非参数相关系数评估这三种系统之间的相关性。使用逻辑回归估计骨折分级系统与韧带撕裂之间的关联。使用精确逻辑回归估计韧带撕裂与胫骨平台骨折位置（内侧与外侧）之间的关联。
90例膝关节中有19例发生胫骨平台骨折。三种胫骨平台分类系统之间存在合理的相关性。Schatzker系统下分级增加与内侧副韧带（MCL）撕裂（P = 0.056）和后外侧角（PLC）撕裂（P = 0.035）具有统计学显著关联。Duparc系统下分级增加与MCL撕裂（P = 0.032）和PLC撕裂（P = 0.058）具有统计学显著关联。PLC撕裂与内侧平台骨折具有统计学显著关联（P = 0.003）；优势比为121.1（95%可信区间：2.2 - ∞）。MCL撕裂与外侧平台骨折具有统计学显著关联（P = 0.004）；优势比为18.4（95%可信区间：2.1 - ∞）。虽然无统计学显著性，但9例外侧平台骨折的膝关节中有8例显示前交叉韧带（ACL）撕裂。
在Schatzker和Duparc胫骨平台骨折分类中，随着分级增加，MCL和PLC撕裂的可能性也增加。在MLKI背景下发生的大多数胫骨平台骨折要么局限于胫骨内侧平台，要么局限于外侧平台。内侧胫骨平台骨折与PLC撕裂相关。外侧胫骨平台骨折与MCL撕裂相关，并且尽管在我们的小样本中无统计学显著性，但9例膝关节中有8例也显示ACL撕裂。
