Yao Xiang, Hu Minjie, Fu Yutong, Liu Hongyuan, Pan Xiaohui, Zhao Jiajun, Tang Jilei
Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China; Jiangsu University, Zhenjiang, Jiangsu, China.
Injury. 2022 Oct;53(10):3494-3501. doi: 10.1016/j.injury.2022.07.018. Epub 2022 Jul 14.
The aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures.
Computed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed.
In total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified.
Among the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.
本研究旨在分析五条主要韧带近端撕脱的发生率，并修正胫骨平台骨折的对角张力/压缩概念。
采用OTA/AO分类法和四柱九段分类法，对1263例胫骨平台骨折的计算机断层扫描图像进行回顾性分析。分析五条韧带近端撕脱与损伤机制之间的相关性。
共纳入1253例患者的1263例胫骨平台骨折。在从本机构数据库获得的1263例胫骨平台骨折病例中，共识别出92例（7.3%）伴有近端撕脱。这92例撕脱发生在82例患者中，其中10例患者在单膝出现两种不同的撕脱。内侧副韧带和外侧副韧带近端撕脱骨折的发生率分别为3.6%（45/1263）和2.1%（26/1263）。前交叉韧带撕脱和后交叉韧带撕脱的发生率则低得多，分别为0.2%（2/1263）和0.1%（1/1263）。髌韧带近端撕脱18例（发生率=1.4%）。识别出几种由胫骨平台远端骨折和韧带近端撕脱组成的损伤组合。
在胫骨平台骨折患者中，五条韧带近端撕脱的发生率为7.3%（92/1263）。四柱九段分类法是记录这些韧带损伤的一种详尽方法。修正后的对角损伤概念有助于理解损伤机制并选择合适的手术策略。
