School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.
Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
Int Orthop. 2021 May;45(5):1287-1298. doi: 10.1007/s00264-020-04864-8. Epub 2020 Oct 29.
To evaluate the overall incidence and types of anterior cruciate ligament (ACL) injuries and posterior cruciate ligament (PCL) injuries associated with tibial plateau fractures (TPFs) following closed reduction and internal fixation (CRIF), and to identify the relationship between the incidence and types of cruciate ligamentous injuries with Schatzker classification and "three-column" classification.
From January 2016 to January 2018, 185 patients with closed TPFs who underwent CRIF were included in this retrospective study. All patients were performed with arthroscopic examination after CRIF, and then, the incidence and types of cruciate ligamentous injuries were recorded and evaluated.
The overall incidence rates of cruciate ligamentous injuries associated with TPFs were 37.3% with 21.6% of these being ACL injuries and 15.7% had PCL injuries. Importantly, patients with fractures in "two-column" fractures have a significantly higher incidence rate of ACL avulsion fracture and PCL complete tears (P < 0.05) than other fracture types, especially involving anteromedial and posterior column fractures. In addition, the incidence of PCL partial tears in patients with three-column involvement was 11.8%, which was higher than other fracture patterns based on three-column classification system (P < 0.05). In the current study, Schatzker IV was most commonly associated with ACL injuries, occurring in 48.1% of our series. Furthermore, PCL injuries occurred at a significantly higher incidence in Schatzker VI with 34.5% than other fracture types (P < 0.05). Statistical analysis revealed that there was a significant difference between Schatzker classification and incidence of injury to the ACL (P < 0.05) and PCL (P < 0.05). Of note, avulsion fracture was the most common types of ACL injuries which was observed in 45% ACL injuries, while partial tear was the most common types of PCL injuries. However, no significant relationship was identified between the types of cruciate ligamentous injuries and Schatzker classification (P > 0.05).
In the recognition of concomitant cruciate ligamentous injuries associated with TPFs based on Schatzker classification and three-column classification, orthopaedic trauma surgeons may better guide optimal surgical protocols for patients.
评估胫骨平台骨折（TPF）经闭合复位内固定（CRIF）后与前交叉韧带（ACL）和后交叉韧带（PCL）损伤相关的总体发生率和类型，并确定与 Schatzker 分类和“三柱”分类相关的交叉韧带损伤发生率和类型之间的关系。
本回顾性研究纳入了 2016 年 1 月至 2018 年 1 月期间接受 CRIF 的 185 例闭合性 TPF 患者。所有患者均在 CRIF 后行关节镜检查，并记录和评估交叉韧带损伤的发生率和类型。
TPF 合并交叉韧带损伤的总体发生率为 37.3%，其中 ACL 损伤占 21.6%，PCL 损伤占 15.7%。重要的是，“两柱”骨折患者 ACL 撕脱骨折和 PCL 完全撕裂的发生率明显高于其他骨折类型（P<0.05），尤其是涉及前内侧柱和后柱骨折的患者。此外，三柱受累患者 PCL 部分撕裂的发生率为 11.8%，高于基于三柱分类系统的其他骨折类型（P<0.05）。在本研究中，Schatzker Ⅳ型最常与 ACL 损伤相关，占本研究系列的 48.1%。此外，Schatzker Ⅵ型 PCL 损伤的发生率明显高于其他骨折类型（P<0.05），为 34.5%。统计分析显示，Schatzker 分类与 ACL（P<0.05）和 PCL（P<0.05）损伤的发生率之间存在显著差异。值得注意的是，撕脱骨折是 ACL 损伤最常见的类型，占 ACL 损伤的 45%，而部分撕裂是 PCL 损伤最常见的类型。然而，交叉韧带损伤的类型与 Schatzker 分类之间没有明显的关系（P>0.05）。
根据 Schatzker 分类和三柱分类，在认识 TPF 合并交叉韧带损伤时，骨科创伤外科医生可以更好地为患者指导最佳的手术方案。
