Yao Xiang, Xu Yong, Yuan Jishan, Lv Bin, Fu Xingli, Wang Lei, Yang Shengquan, Meng Sheng
Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China.
Jiangsu University Health Science Center, Zhenjiang, Jiangsu Province, China.
Injury. 2018 Dec;49(12):2275-2283. doi: 10.1016/j.injury.2018.09.031. Epub 2018 Sep 20.
The existing classification systems of tibial plateau fracture (TPF) are suboptimal for clinical use and academic communication. A more comprehensive and universal classification system with the capability to analyze all patterns of TPF is urgently required to guide the clinical practice. This study aimed to analyze the incidence and fracture characteristics of TPF using a computed tomography-based "four-column and nine-segment" classification.
According to the differentiated morphological characteristics, tibial plateau and proximal fibula were divided into four columns, which were subdivided into nine segments. Tibia plateau injury index (TPII) was innovatively introduced to represent the extent of injury. A total of 698 consecutive adult patients with 704 affected knees were included (377 females, 321 males, mean age 51.6 ± 12.9 years). Fracture mapping was retrospectively analyzed according to the new-style classification system based on the CT imaging.
371 (53.2%) left knees and 321 (46.0%) right knees were injured solely and 6 (0.9%) cases sustained bilateral injuries. The rates of one-column, two-column, three-column and all-four-column injuries were 30.5%, 31.5%, 28.0% and 9.9%, respectively. On average, 2.2 ± 1.0 columns and 3.6 ± 2.1 segments were involved, the mean TPII was 5.7 ± 3.0. The rates of mild, moderate and severe comminuted fractures were 50.0%, 37.5% and 12.5%. The most frequently affected columns were lateral column (572, 81.3%) and intermedial column (524, 74.4%), and the less frequently involved columns were the medial column (219, 31.1%) and fibular column (218, 31.0%). The most frequently affected segments were the posterolateral segment (465, 66.1%), anterolateral segment (453, 64.3%) and posteromedian segment (379, 53.8%). The least frequently involved segment was tubercle segment (85, 12.1%).
The novel "four-column and nine-segment" classification will be a beneficial classification system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.
现有的胫骨平台骨折（TPF）分类系统在临床应用和学术交流方面并不理想。迫切需要一个更全面、通用且能够分析TPF所有类型的分类系统来指导临床实践。本研究旨在使用基于计算机断层扫描的“四柱九段”分类法分析TPF的发病率及骨折特征。
根据不同的形态学特征，将胫骨平台和近端腓骨分为四列，再细分为九段。创新性地引入胫骨平台损伤指数（TPII）来表示损伤程度。共纳入698例连续的成年患者，累及704个患膝（女性377例，男性321例，平均年龄51.6±12.9岁）。根据基于CT成像的新型分类系统对骨折情况进行回顾性分析。
单纯左膝损伤371例（53.2%），单纯右膝损伤321例（46.0%），双侧损伤6例（0.9%）。单柱、双柱、三柱和四柱损伤的发生率分别为30.5%、31.5%、28.0%和9.9%。平均累及2.2±1.0列和3.6±2.1段，平均TPII为5.7±3.0。轻度、中度和重度粉碎性骨折的发生率分别为50.0%、37.5%和12.5%。最常受累的列为外侧列（572例，81.3%）和中间列（524例，74.4%），较少受累的列为内侧列（219例，31.1%）和腓骨列（218例，31.0%）。最常受累的段为后外侧段（465例，66.1%）、前外侧段（453例，64.3%）和后内侧段（379例，53.8%）。最少受累的段为结节段（85例，12.1%）。
新型“四柱九段”分类法将是一种有助于胫骨平台骨折临床诊断、统计分析和预后判断的分类系统。
