Yao Xiang, Liu Hongyuan, Ma Yuxuan, Hu Minjie, Wang Chong, Miao Han, Liu ShengJie, Tang Jilei
Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Jiangsu University, Zhenjiang, China.
Orthop Surg. 2024 Aug;16(8):1903-1911. doi: 10.1111/os.14122. Epub 2024 Jun 19.
Tibial tubercle is a crucial player in maintaining the structural integrity and functional stability of the knee joint. Currently, there is no standardized protocol for the classification and treatment of tibial tubercle fractures in adults. This study analyzed the incidence and treatment strategies of tibial tubercle fractures in adults according to the four-column and nine-segment classification system.
Data of patients with proximal tibial fractures involving tibial tubercle fractures who were treated at our hospital from August 2007 to March 2023 were retrospectively reviewed. The fractures were classified using the AO/OTA classification and four-column and nine-segment classification systems, and the treatment protocol (surgically treated or conservatively treated) was recorded. The number and distribution proportion of patients were counted. A two-sided t-test was conducted to determine the significance of differences between the gender and sides.
In total, 169 tibial tubercle fractures were found in 1484 proximal tibial fractures. According to the AO/OTA classification, seven of the 169 patients, (4.1%) were type A, 36 patients (21.3%) were type B, and 126 patients (74.6%) were type C. According to the four-column and nine-segment classification, type 1 cleavage without free fragments was the most common type of fracture (93/169, 55.0%), followed by type 2 dissociative segmental fragments (48/169, 28.4%) and type 3 comminuted fractures (28/169, 16.6%). Overall, 139 of the 169 proximal tibial fractures with tuberosity involvement were treated surgically. Among them, additional fixation of the tubercle fragment was performed in 52 fractures.
The incidence of tibial tubercle fractures involved in proximal tibial fractures was approximately 11.4% (169/1484) in adults, and approximately one-third of the tubercle bone fragment required additional fixation (30.8%, 52/169). The injury types in the four-column and nine-segment classifications are helpful for accurately judging and making treatment-related decisions for tibial tubercle fractures.
胫骨结节是维持膝关节结构完整性和功能稳定性的关键部位。目前，尚无针对成人胫骨结节骨折的分类和治疗的标准化方案。本研究根据四柱九段分类系统分析了成人胫骨结节骨折的发病率及治疗策略。
回顾性分析2007年8月至2023年3月在我院接受治疗的累及胫骨结节骨折的胫骨近端骨折患者的数据。采用AO/OTA分类系统和四柱九段分类系统对骨折进行分类，并记录治疗方案（手术治疗或保守治疗）。统计患者数量及分布比例。采用双侧t检验确定性别和侧别之间差异的显著性。
在1484例胫骨近端骨折中，共发现169例胫骨结节骨折。根据AO/OTA分类，169例患者中，7例（4.1%）为A型，36例（21.3%）为B型，126例（74.6%）为C型。根据四柱九段分类，1型无游离碎骨片的劈裂骨折是最常见的骨折类型（93/169，55.0%），其次是2型分离性节段性碎骨片骨折（48/169，28.4%）和3型粉碎性骨折（28/169，16.6%）。总体而言，169例累及结节的胫骨近端骨折中，139例接受了手术治疗。其中，52例骨折对结节碎骨片进行了额外固定。
成人胫骨近端骨折累及胫骨结节骨折的发病率约为11.4%（169/1484），约三分之一的结节骨碎骨片需要额外固定（30.8%，52/169）。四柱九段分类中的损伤类型有助于准确判断胫骨结节骨折并做出相关治疗决策。
