CAJ | 학술논문

目的探讨胫骨平台骨折中后内侧和后外侧骨折块的发生率及影像学特点,为胫骨平台后髁骨折内固定治疗提供影像学参考. 方法回顾性分析2012年11月至2014年6月收治且影像学资料完整的298例胫骨平台骨折患者资料,男212例,女86例;平均年龄为47.0岁(18 ～82岁).左侧157例,右侧141例.骨折按Schatzker分型:Ⅰ型12例,Ⅱ型139例,Ⅲ型12例,Ⅳ型40例,Ⅴ型62例,Ⅵ型33例.运用影像归档和通信系统在CT片上判断后内及后外侧骨折块的发生率,并测量后内及后外侧骨块实际最大骨折角(AMFA)、骨折块面积比(SAP)、骨折块矢状角(SA)、骨折块高度(FH)、最大位移(MD)等影像学参数,评价胫骨平台后内及后外侧骨块的影像学特点. 结果 298例胫骨平台骨折患者中,56例(18.8％)出现后内侧骨折块,60例(20.1％％)出现后外侧骨折块,24例(8.1％)同时出现后内和后外侧骨折块.后内和后外侧骨折块AMFA平均分别为59.6°±58.5°、92.2°±53.9°;SAP平均分别为21.4％±9.0％、15.4％±5.9％;SA平均分别为64.9°±14.3°、72.4°±21.3°;FH平均分别为(33.3±8.2)、(27.0±9.8)mm;MD平均分别为(4.3±6.3)、(3.7±6.5) mm,差异均有统计学意义(P＜0.05). 结论胫骨平台骨折中后内及后外侧骨折的发生率较高;由于腓骨的支撑作用,后外侧骨折块面积和移位程度较后内侧骨折块小,因此胫骨平台后柱双髁骨折需根据骨折块的影像学特点选择合适的手术入路和置钉方向.
목적 탐토경골평태골절중후내측화후외측골절괴적발생솔급영상학특점,위경골평태후과골절내고정치료제공영상학삼고. 방법 회고성분석2012년11월지2014년6월수치차영상학자료완정적298례경골평태골절환자자료,남212례,녀86례;평균년령위47.0세(18 ～82세).좌측157례,우측141례.골절안Schatzker분형:Ⅰ형12례,Ⅱ형139례,Ⅲ형12례,Ⅳ형40례,Ⅴ형62례,Ⅵ형33례.운용영상귀당화통신계통재CT편상판단후내급후외측골절괴적발생솔,병측량후내급후외측골괴실제최대골절각(AMFA)、골절괴면적비(SAP)、골절괴시상각(SA)、골절괴고도(FH)、최대위이(MD)등영상학삼수,평개경골평태후내급후외측골괴적영상학특점. 결과 298례경골평태골절환자중,56례(18.8％)출현후내측골절괴,60례(20.1％％)출현후외측골절괴,24례(8.1％)동시출현후내화후외측골절괴.후내화후외측골절괴AMFA평균분별위59.6°±58.5°、92.2°±53.9°;SAP평균분별위21.4％±9.0％、15.4％±5.9％;SA평균분별위64.9°±14.3°、72.4°±21.3°;FH평균분별위(33.3±8.2)、(27.0±9.8)mm;MD평균분별위(4.3±6.3)、(3.7±6.5) mm,차이균유통계학의의(P＜0.05). 결론 경골평태골절중후내급후외측골절적발생솔교고;유우비골적지탱작용,후외측골절괴면적화이위정도교후내측골절괴소,인차경골평태후주쌍과골절수근거골절괴적영상학특점선택합괄적수술입로화치정방향.
Objective To explore the frequencies and morphological characteristics of posteromedial and posterolateral fragments in acute tibial plateau fractures.Methods A retrospective analysis was conducted of the radiographic and computed tomographic (CT) data of the 298 tibial plateau fractures from November 2012 to June 2014 at our department.They involved 212 males and 86 females with an average age of 47.0 years (range,from 18 to 82 years).The left side was affected in 157 cases,and the right side in 141.By the Schatzker classification,there were 12 cases of type Ⅰ,139 ones of type Ⅱ,12 ones of type Ⅲ,40 ones of type Ⅳ,62 ones of type Ⅴ,and 33 ones of type Ⅵ.Frequencies of the posteromedial and posterolateral fragments were calculated on the CT images using the Picture Archiving and Communication System.Of the fragments,actual major fracture angle (AMFA),surface area percentage (SAP),sagittal angle (SA),fracture height (FH),maximum displacement (MD) were measured on CT images to characterize the imageological morphology of posteromedial and posterolateral fragments in acute tibial plateau fractures.Results Of the 298 tibial plateau fractures,the posteromedial fragments were found in 56 (18.8％),the posterolateral fragments in 60 (20.1％),and both the posteromedial and the posterolateral fragments in 24 (8.1％).Of the posteromedial and posterolateral fragments,respectively,AMFA was 59.6° ± 58.5° and 92.2°±53.9°,SAP was 21.4％ ±9.0％ and 15.4％ ±5.9％,SA was 64.9° ± 14.3° and 72.4° ±21.3°,FH was 33.3±8.2 mm and 27.0 ±9.8 mm,and MD was 4.3±6.3 mm and 3.7±6.5 mm,showing significant differences between the posteromedial and posterolateral fragments (P ＜ 0.05).Conclusions Incidence of posteromedial and posterolateral fragments may not be low in tibial plateau fractures.Due to the fibular support,the area and displacement of posterolateral fragments are significantly lower than those of posteromedial fragments.Appropriate approaches and nailing directions should be taken into consideration in posterior bicondylar fractures according to their imaging features.