X线下胫骨平台与股骨远端解剖学测量关系在Schatzker Ⅳ-C胫骨平台骨折术后临床疗效的评估价值  

Radiographic anatomical ratios between tibial plateau and distal femur and the clinical value in evaluating reduction of Schatzker IV⁃C tibial plateau fractures

作　　者：刘雨龙 宁仁德 方闰 郑翰林 张成楠 周道斌 周祖龙 LIU Yulong;NING Rende;FANG Run;ZHENG Han-lin;ZHANG Chengnan;ZHOU Daobin;ZHOU Zulong(Department of Orthopedics,the Third Affiliated Hospital,Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学第三附属医院骨科,合肥230001

出　　处：《实用医学杂志》2024年第9期1257-1261,共5页The Journal of Practical Medicine

基　　金：2022年度安徽省临床重点专科建设项目;安徽医科大学第三附属医院基础与临床合作研究提升计划(编号:2022sfy007)。

摘　　要：目的 测量X线下胫骨平台与股骨远端的解剖学关系,并评估Schatzker Ⅳ-C胫骨平台骨折术中平台宽度复位情况对术后临床疗效的影响。方法 2012年8月至2022年8月,在我院收集207例标准中立位正常成年人膝关节X线(未骨折组)及60例Schatzker Ⅳ-C型骨折患者术前及术后即刻膝关节前后位X线(骨折组)。分别测量两组胫骨近端关节宽度(TAW)、股骨远端髁宽度(DFW)及股骨远端关节宽度(FAW),计算TAW/DFW和TAW/FAW比值,定义骨折组术后即刻X线TAW介于FAW与DFW之间为复位良好组,反之为复位不良组,并在术后1年对两组进行膝关节美国特种外科医院评分(HSS)。结果 在未骨折组中,TAW/DFW和TAW/FAW比值无明显性别或侧别差异(P> 0.05),而骨折组术前与未骨折组TAW/DFW和TAW/FAW比值差异有统计学意义(P <0.05)。骨折组中复位良好组与复位不良组的术后1年HSS评分比较差异有统计学意义(P <0.05)。结论 正常成年人胫骨平台与股骨远端的X线下解剖学关系相对恒定,可为Schatzker Ⅳ-C骨折术中平台宽度复位提供影像学参考,若术后复位后X线TAW/DFW> 1或TAW/FAW <1提示复位不佳,则预示术后膝关节功能恢复不良。Objective To investigate the radiographic anatomical relationship between tibial plateau and distal femur and evaluate the impact of reset tibial plateau of various widths after reduction of the Schatzker IV-C tibial plateau fractures on postoperative outcomes.Methods We collected and reviewed the X-ray images of the normal knees of 207 standard neutrally-positioned adults(non-fracture group)and pre-and post-operative immediate anterior-posterior X-ray images of the knees of 60 patients with Schatzker IV-C fractures(fracture group)in our hospital from August 2012 to August 2022.We measured the proximal tibial joint width(TAW),distal femoral width(DFW),and distal femoral joint width(FAW)in both groups and calculated the TAW/DFW and TAW/FAW ratios.In the fracture group,the cases with TAW between FAW and DFW were assigned to the well-reduced group,while those with TAW outside this range between FAW and DFW to the poorly-reduced group.Both groups were assessed using the Hospital for Special Surgery knee score(HSS)one year after operation.Results In the non-fracture group,there were no significant differences in gender or affected side in terms of TAW/DFW and TAW/FAW ratios(P>0.05),while in the fracture group,there were statistically significant differences in the TAW/DFW and TAW/FAW ratios compared to the non-fracture group(P<0.05).There was a statistically signifi⁃cant difference in the one-year postoperative HSS scores between the well-reduced and poorly-reduced groups in the fracture group(P<0.05).Conclusion The radiographic anatomical relationship between the tibial plateau and distal femur in normal adults is relatively constant,providing a radiological reference for resetting the tibial plateau 9to a satisfactory width during reduction of Schatzker IV-C fractures. TAW/DFW > 1 or TAW/FAW < 1 indicates a poor reduction of the fracture and predicts poor postoperative recovery of knee joint function.

关 键 词：SchatzkerⅣ-C X线 骨折复位 膝关节功能 

分 类 号：R683.42[医药卫生—骨科学]