中国组织工程研究

中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (13): 2076-2080.doi: 10.12307/2023.311

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

X射线测量成人胫骨外侧平台与股骨外侧髁解剖关系在骨折复位中的意义

方  闰，宁仁德，刘雨龙，毕程浩，周道斌   

  1. 安徽医科大学第三附属医院骨科，安徽省合肥市   230061
  • 收稿日期:2022-03-21 接受日期:2022-05-11 出版日期:2023-05-08 发布日期:2022-08-12
  • 通讯作者: 宁仁德，博士，主任医师，安徽医科大学第三附属医院骨科，安徽省合肥市 230061
  • 作者简介:方闰，男，1993年生，安徽省安庆市人，汉族，2020年安徽医科大学毕业，硕士，医师，主要从事骨关节疾病方面的研究。
  • 基金资助:
    卫生健康应用医学研究项目(临床)资助项目(201917201)，项目负责人：宁仁德

Significance of X-ray measurement of the anatomical relationship between adult lateral tibial plateau and lateral femoral condyle in fracture reduction

Fang Run, Ning Rende, Liu Yulong, Bi Chenghao, Zhou Daobin   

  1. Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui Province, China
  • Received:2022-03-21 Accepted:2022-05-11 Online:2023-05-08 Published:2022-08-12
  • Contact: Ning Rende, MD, Chief physician, Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui Province, China
  • About author:Fang Run, Master, Physician, Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei 230061, Anhui Province, China
  • Supported by:
    the Health Applied Medicine Project, No. 201917201 (to NRD)

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摘要：

文题释义：
胫骨平台骨折：与股骨远端相对应的面为胫骨平台，累及胫骨平台关节面或干骺端的骨折称为胫骨平台骨折，胫骨平台骨折在临床上较为常见，占全身骨折的1%-2%。多数胫骨平台骨折需要通过手术治疗，手术治疗的目的是恢复关节面的平整、韧带的完整性及膝关节功能。
Schatzker分型：是SCHATZKER于1979年提出的应用于胫骨平台骨折的分型，其特点是简单实用，临床应用广泛。Ⅰ型指外侧平台劈裂骨折，无关节面塌陷；Ⅱ型指外侧平台劈裂伴有关节面压缩；Ⅲ型指外侧平台单纯压缩骨折；Ⅳ型指内侧平台骨折；Ⅴ型指双侧平台骨折；VI型指双侧平台骨折加胫骨干与干骺端分离。

背景：胫骨平台骨折术中平台宽度恢复与否，目前临床尚无统一参考标准，其对术后膝关节功能影响，国内外研究较少。
目的：探究成人胫骨外侧平台与股骨外侧髁的解剖位置关系及其在Schatzker Ⅱ型胫骨平台骨折宽度复位中的临床意义。
方法：回顾性分析2019年12月至2021年6月安徽医科大学第三附属医院拍摄的标准中立位正常成人膝关节X射线片148例208膝(正常组)，以及Schatzker Ⅱ型胫骨平台骨折患者58例(58膝)术前及术后1年标准中立位膝关节X射线片(骨折组)。定义胫骨平台最外侧点为A点，股骨远端关节面最外侧点为B点，股骨外侧髁最外侧点为C点，分别测量A-B与A-C的水平距离，若B点在A点内侧记做(-)，在A点外侧记做(+)，同理记录A-C值。正常组按照男女及左右侧分组，进行组间对比，以发现成人胫骨外侧平台与股骨外侧髁的解剖位置关系。同时对Schatzker Ⅱ型胫骨平台骨折患者进行术后1年膝关节美国特种外科医院评分，定义复位后A点在C点内侧为甲组，A点在C点外侧为乙组，比较甲、乙组的膝关节功能。
结果与结论：①正常组男性、女性平均A-B值相比，差异无显著性意义(t=-1.86，P > 0.05)；正常组男性、女性平均A-C值相比，差异无显著性意义(t=0.70，P > 0.05)；正常组左侧、右侧平均A-B值相比，差异无显著性意义(t=-0.67，P > 0.05)；正常组左侧、右侧平均A-C值相比，差异无显著性意义(t=1.09，P > 0.05)；②正常组平均A-B值为(-3.60±0.84) mm，骨折组术前平均A-B值为(-5.28±1.16) mm，组间对比差异有显著性意义(t=10.28，P < 0.05)；正常组平均A-C值为(1.80±1.26) mm，骨折组术前平均A-C值为(1.09±2.18) mm，组间对比差异有显著性意义(t=2.37，P < 0.05)；③骨折组中甲组术后1年膝关节美国特种外科医院评分为(83.05±2.04)分，乙组为(75.97±1.91)分，组间对比差异有显著性意义(t=13.25，P < 0.05)；④提示成人胫骨外侧平台与股骨外侧髁的解剖学位置关系相对恒定，术中胫骨平台宽度复位不佳是术后膝关节功能下降的重要影响因素。

https://orcid.org/0000-0002-1434-5902 (方闰)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 胫骨平台, 宽度, 胫骨平台骨折, 膝关节功能, 骨折复位

Abstract: BACKGROUND: There is no unified clinical reference standard for the recovery of the plateau width during the operation of tibial plateau fracture, and there are few studies on its effect on the postoperative knee function at home and abroad.  
OBJECTIVE: To explore the anatomical relationship between adult lateral tibial plateau and lateral femoral condyle and its clinical significance about width reduction in Schatzker II tibial plateau fractures.
METHODS:  The X-ray films of knee joint of 148 normal adults (208 knees) in normal neutral position (normal knee group) and X-ray films of Schatzker II tibial plateau fractures of 58 cases (58 knees) (fracture group) from December 2019 to June 2021 in the Third Affiliated Hospital of Anhui Medical University were retrospectively analyzed. The lateral-most margins of the tibial plateau articular surface were defined as point A; the lateral femoral condyle articular surface was defined as point B; the lateral femoral epicondyle was defined as point C; the horizontal distances of A-B and A-C were measured separately; medial and lateral measurements to point A were recorded as (-) and (+). The A-C distance was recorded in the same way. They were grouped by sex and side factors, and the comparison between the groups was performed to find the anatomical relationship between the adult lateral tibial plateau and lateral femoral condyle. The Hospital for Special Surgery scale was performed for one year after surgery of Schatzker II tibial plateau fractures. After reduction, point A on the inside of point C was defined as group A and point A on the outside of point C was defined as group B; the knee function of group A and group B was compared.  
RESULTS AND CONCLUSION: (1) There was no significant difference in the mean A-B distance of the normal knee group between males and females (t=-1.86, P > 0.05). There was no significant difference in the mean A-C distance of the normal knee group between males and females (t=0.70, P > 0.05). There was no significant difference in the mean A-B distance of the normal knee group between the left side and the right side (t=-0.67,P > 0.05). There was no significant difference in the mean A-C distance of the normal knee group between the left side and the right side (t=1.09, P > 0.05). (2) The mean A-B distance of the normal knee group was (-3.60±0.84) mm and the mean preoperative A-B distance of the fracture group was (-5.28±1.16) mm; there was significant difference between groups (t=10.28, P < 0.05). The mean A-C distance of the normal knee group was (1.80±1.26) mm and the mean preoperative A-C distance of the fracture group was (1.09±2.18) mm; there were significant differences between groups (t=2.37, P < 0.05). (3) The mean Hospital for Special Surgery scale for one year after surgery was (83.05±2.04) points of group A and (75.97±1.91) points of group B; there were significant differences between groups (t=13.25, P < 0.05). (4) It is concluded that the anatomical position relationship between the lateral tibial plateau and the lateral femoral condyle in adults is relatively constant, and poor intraoperative reduction of the width of the tibial plateau is an important influencing factor of decreased knee function after surgery.

Key words: tibial plateau, width, tibial plateau fracture, knee joint function, fracture reduction

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