Chen Yan-Dong, Chen Shu-Xiang, Liu Hong-Guang, Zhao Xiang-Sheng, Ou Wen-Huan, Li Huan-Xi, Huang Hong-Xing
3 Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China.
Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China.
World J Clin Cases. 2021 Jan 6;9(1):81-90. doi: 10.12998/wjcc.v9.i1.81.
Computed tomography (CT) has become a routine preoperative examination for tibial plateau fractures (TPFs). Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information; however, the evaluation of traumatic meniscal lesion (TML) and arthroscopic management are controversial.
To predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT.
Acute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study. The type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology included the following: Frontal fragment width of plateau, sagittal fragment subsiding distance (FSD), sagittal fracture line distance, sagittal posterior tibial slope, and transversal area ratio of fragment area) on preoperative CT three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.
A total of 67 patients were enrolled in this study, among which 30 patients had TMLs, lateral/medial (23/7). FSD was a particularly positive factor to predict TML, with odds ratio of 2.31 (1.26-5.63). On sagittal view of CT, FSD degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of TML in bicondylar TPFs. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs.
TML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.
计算机断层扫描（CT）已成为胫骨平台骨折（TPF）术前的常规检查。评估骨折块的位置和髁间隆起骨折可为临床医生提供有价值的信息；然而，创伤性半月板损伤（TML）的评估及关节镜治疗仍存在争议。
通过术前薄层CT上单侧TPF和双侧TPF的三维骨骼解剖结构变化预测TML。
本回顾性研究纳入了2017年12月至2019年12月期间接受关节镜手术的急性胫骨平台骨折患者。根据手术记录和/或关节镜视频诊断TML的类型、区域和位置。术前CT三维平面上三维骨折形态的测量包括：平台的额状骨折块宽度、矢状骨折块塌陷距离（FSD）、矢状骨折线距离、矢状胫骨后倾角以及骨折块面积的横截面积比。根据单髁TPF和双髁TPF计算TML与骨骼值的相关性。
本研究共纳入67例患者，其中30例有TML，外侧/内侧（23/7）。FSD是预测TML的一个特别积极的因素，优势比为2.31（1.26 - 5.63）。在CT矢状面上，双髁TPF中FSD为8 mm且胫骨后倾角超过11.74°意味着TML风险增加。在冠状面上，一旦平台骨折块宽度超过3 cm，TML发生率达到100%。在横断面上，单髁TPF中骨折块面积比增加5.5%且FSD > 4.3 mm对预测TML有意义。
根据单髁骨折和双髁TPF，可通过术前CT图像上的不同参数预测TML。
