术前MSCT对胫骨平台骨折伴半月板损伤的诊断价值  

Diagnostic value of MSCT in tibial plateau fracture with meniscus injury before operation

作　　者：董方[1] 解耀锃[2] 周恩昌[3] 路新震 DONG Fang;XIE Yaozeng;ZHOU Enchang;LU Xinzhen(Department of Traumatology and Orthopaedics,Second People's Hospital of Liaocheng,Liaocheng,Shandong 252600,China;CT Room,Second People's Hospital of Liaocheng,Liaocheng,Shandong 252600,China;Department of Joint Surgery,Second People's Hospital of Liaocheng,Liaocheng,Shandong 252600,China)

机构地区：[1]聊城市第二人民医院创伤骨科,山东聊城252600 [2]聊城市第二人民医院CT室,山东聊城252600 [3]聊城市第二人民医院关节外科,山东聊城252600

出　　处：《安徽医药》2025年第1期91-95,I0006,共6页Anhui Medical and Pharmaceutical Journal

基　　金：山东省医药卫生科技发展计划项目(2019WS106)。

摘　　要：目的探讨术前多层螺旋计算机断层扫描(MSCT)对胫骨平台骨折伴半月板损伤的诊断价值。方法回顾2017年1月至2022年12月聊城市第二人民医院收治的83例行胫骨平台骨折内固定术治疗病人的临床资料,术前均接受MSCT检查,以术中骨折复位内固定后即刻关节镜下所见有无发生半月板损伤为金标准分为半月板损伤组和无半月板损伤组。比较两组病人基线资料及MSCT参数,绘制受试者操作特征曲线(ROC曲线)分析MSCT参数对复杂胫骨平台骨折伴半月板损伤的诊断价值。结果83例胫骨平台骨折病人发生半月板损伤共39例(46.99%),Ⅳ型半月板损伤发生率为18.75%(3/16),低于Ⅱ型的59.52%(25/42)(P<0.05)。半月板损伤组中SchatzkerⅡ型占比高于无半月板损伤组,SchatzkerⅣ型占比及术前MSCT检测骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积高于低于无半月板损伤组(P<0.05)。ROC曲线分析显示,骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积单独及联合应用诊断胫骨平台骨折伴半月板损伤的ROC曲线下面积(AUC)(95%CI)为0.64(0.56,0.72)、0.70(0.62,0.78)、0.76(0.67,0.83)、0.89(0.83,0.94),联合应用的诊断价值高于单独应用(P<0.05)。结论术前MSCT测量胫骨平台骨折外侧髁切线至骨折块远端距离、塌陷相对面积等参数对半月板损伤的诊断有重要参考价值。Objective To evaluate the diagnostic value of preoperative multi-slice computed tomography(MSCT)in tibial plateau fracture with meniscus injury.Methods The clinical data of 83 patients admitted to Liaocheng Second People´s Hospital from January 2017 to December 2022 who were proposed to be treated with internal fixation of tibial plateau fractures were reviewed.All patients underwent preoperative MSCT and were divided into meniscus injury group and no meniscus injury group based on the gold standard of whether meniscal injury occurred as seen arthroscopically immediately after intraoperative fracture reduction and internal fixation.Baseline data and MSCT parameters were compared between the two groups.Subject work characteristic curve(ROC curve)was plotted to analyse the diagnostic value of MSCT parameters in complex tibial plateau fracture with meniscus injury.Results Meniscus injury occurred in 39(46.99%)cases of 83 patients with tibial plateau fractures,and the incidence of meniscus injury in typeⅣwas 18.75%(3/16),which was lower than that in typeⅡ 59.52%(25/42)(P<0.05).The percentage of Schatzker typeⅡwas higher in the meniscus injury group than that in the no meniscus injury group,and the percentage of Schatzker typeⅣ,the distance from the fracture tangent line to the lowest point of collapse,the distance from the lateral condyle tangent line to the distal end of the fracture block,and the relative area of collapse detected by preoperative MSCT were higher than those in the no meniscus injury group(P<0.05).ROC curve analysis showed that the area under ROC curve(AUC)(95%CI)for fracture tangent line to nadir of collapse distance,lateral condyle tangent line to distal fracture block distance,and relative area of collapse alone and in combination for diagnosing meniscal injury of tibial plateau fractures was 0.64(0.56,0.72),0.70(0.62,0.78),0.76(0.67,0.83),and 0.89(0.83,0.94),with the diagnostic value of the combined application being higher than that single application(P<0.05).Conclusion Preoperative MS

关 键 词：胫骨半月板损伤 多层螺旋计算机断层扫描 胫骨平台骨折 半月板损伤 SCHATZKER分型 诊断 

分 类 号：R687.3[医药卫生—骨科学]