Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Jiangsu University, Zhenjiang, Jiangsu, China.
Int Orthop. 2022 Oct;46(10):2373-2383. doi: 10.1007/s00264-022-05499-7. Epub 2022 Jul 13.
This study was aimed at analyzing the incidence and characteristics of hyperextension tibial plateau fractures (HTPFs) by using a computed tomography (CT)-based "four-column and nine-segment" classification.
In the coronal plane, HTPFs are divided into four types: pure hyperextension, hyperextension-varus, hyperextension-valgus, and hyperextension-bicondylar. Fractures in the sagittal plane were divided into three types: type 1, pure depression; type 2, cleavage extending to the posterior cortex with no displacement; and type 3, cleavage extending to the posterior cortex with a significant displacement. A retrospective analysis of CT images of the tibial plateau fractures from December 2007 to December 2021 was conducted. Fracture mapping was analyzed and drawn using the new classification system.
A total of 136 (10.9%, 136/1253) fractures fulfilled the radiographic criteria for HTPF pattern in 136 knees (53.5 ± 13.3 years). There were 11 knees with pure hyperextension fracture (8.1%), 23 with hyperextension-varus fracture (16.9%), 46 with hyperextension-valgus fracture (33.8%), and 56 with hyperextension-bicondylar fracture (41.2%) in the coronal plane. Furthermore, there were 64 (47.1%), 47 (34.6%), and 25 (18.4%) cases of type 1, type 2, and type 3 fractures, respectively, in the sagittal plane. In the three-dimensional heat map, the fracture lines were mainly located at the anterior rim of the tibial plateau, while the posterior articular surface was rarely involved.
The main manifestations of HTPF are anterior compression and posterior avulsion injury. The CT-based four-column and nine-segment classification system could be used to categorize the injury characteristics of HTPF in the coronal and sagittal planes.
本研究旨在利用基于计算机断层扫描（CT）的“四柱九段”分类方法分析胫骨平台后倾骨折（HTPF）的发生率和特征。
冠状面中，HTPF 分为四型：单纯后倾、后倾-内翻、后倾-外翻和后倾-双髁。矢状面骨折分为三型：1 型，单纯压缩；2 型，后皮质撕裂但无移位；3 型，后皮质撕裂伴明显移位。对 2007 年 12 月至 2021 年 12 月间的胫骨平台骨折 CT 图像进行回顾性分析。采用新分类系统对骨折进行分析和绘图。
136 个（10.9%，136/1253）膝关节的 X 线片符合 HTPF 影像学标准，共 136 个膝关节（53.5±13.3 岁）。冠状面中，单纯后倾骨折 11 个（8.1%），后倾-内翻骨折 23 个（16.9%），后倾-外翻骨折 46 个（33.8%），后倾-双髁骨折 56 个（41.2%）。矢状面中，1 型、2 型和 3 型骨折分别为 64 个（47.1%）、47 个（34.6%）和 25 个（18.4%）。三维热图中，骨折线主要位于胫骨平台前缘，后关节面很少受累。
HTPF 的主要表现为前侧压缩和后侧撕脱损伤。基于 CT 的“四柱九段”分类系统可用于冠状面和矢状面 HTPF 损伤特征的分类。
