Deng X T, Zheng Z Z, Shao D C, Lian X D, Zhu J, Hu H Z, Zhang Y Z
Nankai University School of Medicine, Tianjin 300071, China.
Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
Zhonghua Wai Ke Za Zhi. 2021 Jun 1;59(6):464-469. doi: 10.3760/cma.j.cn112139-20200914-00704.
To investigate the types of meniscal tears and cruciate ligamentous injuries in patients with tibial plateau fracture(TPF) following arthroscopic examination. The clinical data of 216 patients with TPF who underwent closed reduction and internal fixation (CRIF) from January 2016 to January 2019 at Trauma Emergency center, the Third Hospital of Hebei Medical University were analyzed retrospectively. There were 147 males (147 knees) and 69 females (69 knees),aged 46.3 years (range: 18 to 80 years). All patients underwent closed reduction for the displaced fracture fragment with the use of bidirectional rapid redactor,and minimally invasive percutaneous plate osteosynthesis. Intra-operative arthroscopic examination was performed to exam the stability of meniscus and the continuity of cruciate ligamentous after CRIF. The percentages and types of meniscal tears and cruciate ligamentous injuries were recorded. The overall percentages of meniscal tears associated with TPFs was 48.6%(105/216). The most common pattern of meniscal tears was longitudinal tears, accounting for 43.8% (46/105), and it occurred most frequently in Schatzker type Ⅱ (58.7%, 27/46). Furthermore, the percentage of meniscal complex tears was 17.1% (18/105), occurring most frequently in Schatzker type Ⅴ (9/18). The overall percentage of cruciate ligamentous injuries associated with TPFs was 17.1% (37/216), and the percentages of anterior cruciate ligament (ACL) injuries was 64.9%(24/37), the percentage of posterior cruciate ligament injuries was 35.1%(13/37). Avulsion fracture was the most common pattern in ACL injuries, accounting for 41.7% (13/24), and all occurred in the tibial insertion site. In the present study, the percentages of meniscal tears and ligamentous injuries in TPFs are 48.6% and 17.1%, respectively. The most common types are meniscal longitudinal tears and ACL injury, occurring most frequently in Schatzker type Ⅱ and Ⅳ, respectively. Recognition of concomitant meniscal tears and cruciate ligamentous injuries in TPFs is helpful for trauma physicians to choose the best surgical treatment.
通过关节镜检查，调查胫骨平台骨折（TPF）患者半月板撕裂和交叉韧带损伤的类型。回顾性分析2016年1月至2019年1月在河北医科大学第三医院创伤急救中心接受闭合复位内固定（CRIF）治疗的216例TPF患者的临床资料。其中男性147例（147膝），女性69例（69膝），年龄46.3岁（范围：18至80岁）。所有患者均使用双向快速复位器对移位的骨折块进行闭合复位，并采用微创经皮钢板接骨术。CRIF术后进行术中关节镜检查，以检查半月板的稳定性和交叉韧带的连续性。记录半月板撕裂和交叉韧带损伤的百分比及类型。与TPF相关的半月板撕裂的总体百分比为48.6%（105/216）。半月板撕裂最常见的类型是纵行撕裂，占43.8%（46/105），最常发生于SchatzkerⅡ型（58.7%，27/46）。此外，半月板复合撕裂的百分比为17.1%（18/105），最常发生于SchatzkerⅤ型（9/18）。与TPF相关的交叉韧带损伤的总体百分比为17.1%（37/216），前交叉韧带（ACL）损伤的百分比为64.9%（24/37），后交叉韧带损伤的百分比为35.1%（13/37）。撕脱骨折是ACL损伤最常见的类型，占41.7%（13/24），且均发生于胫骨附着点。在本研究中，TPF患者半月板撕裂和韧带损伤的百分比分别为48.6%和17.1%。最常见的类型是半月板纵行撕裂和ACL损伤，分别最常发生于SchatzkerⅡ型和Ⅳ型。认识TPF患者合并的半月板撕裂和交叉韧带损伤，有助于创伤外科医生选择最佳的手术治疗方案。
