胫骨平台外侧髁骨折CT图像与内侧副韧带完全断裂的相关分析  

Correlation analysis for the lateral condylar tibial plateau fracture and complete medial collateral ligament rupture

作　　者：魏学磊[1] 孙杰[1] 赵晖[2] 鲁杰[1] 卢艳东[1] 罗嗣频 崔猛[1] 刘云蛟 张玺[1] 李方国[1] Wei Xuelei;Sun Jie;Zhao Hui;Lu Jie;Lu Yandong;Luo Sipin;Cui Meng;Liu Yunjiao;Zhang Xi;Li Fangguo(Department of the Second Trauma Knee Joint,Tianjin Hospital,Tianjin University,Tianjin 300211,China;Department of the First Radiology,Tianjin Hospital,Tianjin University,Tianjin 300211,China)

机构地区：[1]天津市天津医院(天津大学天津医院)创伤膝关节二科,天津300211 [2]天津市天津医院(天津大学天津医院)放射一科,天津300211

出　　处：《中华骨科杂志》2023年第3期179-184,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨胫骨平台外侧髁骨折CT图像与内侧副韧带(medial collateral ligament,MCL)完全断裂的关系。方法2020年1月至2021年11月就诊于天津大学天津医院的合并MCL损伤的胫骨平台外侧髁骨折患者59例,男32例、女27例,年龄(42.4±12.3)岁(范围19~65岁);伸直型损伤26例,屈曲型损伤33例。根据术前MRI和术中完成骨折固定后的外翻应力试验将患者分为MCL部分损伤组和完全断裂组。在CT片上按照孙杰等提出的胫骨平台外侧髁ABC骨折分型确定骨折位置并测量胫骨外侧平台塌陷深度(lateral plateau depression,LPD)。通过受试者工作特征(receiver operating characteristic,ROC)曲线分析LPD与MCL完全断裂的关系。结果59例胫骨平台外侧髁骨折合并MCL损伤患者中部分损伤42例、完全断裂17例;按照ABC骨折分型:伸直型损伤(累及A区)26例,包括AB型21例、ABC型5例;屈曲型损伤33例,包括B型19例、BC型12例、C型2例。其中17例MCL完全断裂均发生于伸直型损伤,包括AB型14例、ABC型3例。MCL完全断裂组和部分损伤组LPD分别为(11.7±5.3)mm(范围4.3~28.1 mm)和(11.5±4.8)mm(范围3.8~23.6 mm),两者比较差异无统计学意义(t=0.11,P=0.567);LPD诊断MCL损伤的ROC曲线下面积(area under the curve,AUC)为0.504。伸直型损伤患者26例,其中MCL完全断裂17例、部分损伤9例,LPD分别为(11.7±5.3)mm(范围4.3~28.1 mm)和(6.6±1.8)mm(范围3.8~9.4 mm),差异有统计学意义(t=3.57,P=0.009);LPD诊断MCL损伤的最佳预测截断值为7.25 mm,灵敏度为88.2%,特异度为77.8%,AUC为0.868。结论当胫骨平台外侧髁骨折位于伸直型损伤区且在冠状面CT片上测量LPD>7.25 mm时应特别注意是否合并MCL完全断裂,在完成骨折固定手术后需要对MCL进行修复。Objective To investigate the relationship between the CT images of a lateral condylar tibial plateau fractures and complete medial collateral ligament(MCL)injury.Methods Data of 59 patients with lateral condylar fracture of tibial plateau complicated with MCL injury admitted to Tianjin Hospital from January 2020 to November 2021 were collected,including 32 males and 27 females,aged 42.4±12.3 years(range,19-65 years),there were 26 cases of extension injury and 33 cases of flexion injury.The patients were separated into two groups:those with partial MCL injury and those with total rupture based on preoperative MR examination and intraoperative valgus stress test following fracture fixation.According to the ABC fracture classification of lateral condyle tibial plateau proposed by Sun et al.,the fracture locations were determined on CT images,and the lateral plateau collapse depth(LPD)was measured.The relationship between LPD and MCL complete rupture was analyzed by receiver operating characteristic(ROC)curve.Results Among 59 patients with lateral condylar tibial plateau fracture and MCL injury,42 had partial injuries and 17 had complete ruptures.According to the ABC fracture classification,there were 26 cases of extension injury(involving area A),21 cases of AB type,and 5 cases of ABC type;and 33 cases of flexion type injury,19 cases of B type,12 cases of BC type,and 2 cases of C type.All the 17 cases of MCL complete fracture occurred in extension injury,including type AB(14 cases)and type ABC(3 cases).The difference between the mean LPDs of the MCL full rupture group and the partial injury group was not statistically significant(t=0.11,P=0.567),and the mean LPDs of both groups were 11.7±5.3 mm(range,4.3-28.1 mm)and 11.5±4.8 mm(range,3.8-23.6 mm),respectively.The area under the curve(AUC)of the ROC curve analysis was 0.504,and there was no statistical correlation between lateral platform collapse depth and MCL injury.Among the 26 patients with extensional injury area,MCL was completely ruptures in 17 cases and pa

关 键 词：胫骨骨折 内侧副韧带 膝 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学]