胫骨平台骨折中的胫股骨轴向旋转：对 203 例胫骨平台骨折的回顾性放射学评估。

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2024-07-31 DOI:10.1016/j.knee.2024.07.014

Hanne Bartels , Han-po Tseng , Nathalie Noppe , Harm Hoekstra

{"title":"胫骨平台骨折中的胫股骨轴向旋转：对 203 例胫骨平台骨折的回顾性放射学评估。","authors":"Hanne Bartels , Han-po Tseng , Nathalie Noppe , Harm Hoekstra","doi":"10.1016/j.knee.2024.07.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation.</p></div><div><h3>Methods</h3><p>The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed.</p></div><div><h3>Results</h3><p>Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (<em>P</em> = 0.964) or extent of rotation (H(8) = 7.116, <em>P</em> = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF.</p></div><div><h3>Conclusion</h3><p>Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.</p></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"50 ","pages":"Pages 9-17"},"PeriodicalIF":1.6000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tibiofemoral axial rotation in tibial plateau fractures: A retrospective radiographic assessment of 203 tibial plateau fractures\",\"authors\":\"Hanne Bartels , Han-po Tseng , Nathalie Noppe , Harm Hoekstra\",\"doi\":\"10.1016/j.knee.2024.07.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation.</p></div><div><h3>Methods</h3><p>The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed.</p></div><div><h3>Results</h3><p>Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (<em>P</em> = 0.964) or extent of rotation (H(8) = 7.116, <em>P</em> = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF.</p></div><div><h3>Conclusion</h3><p>Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.</p></div>\",\"PeriodicalId\":56110,\"journal\":{\"name\":\"Knee\",\"volume\":\"50 \",\"pages\":\"Pages 9-17\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-07-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Knee\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0968016024001108\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0968016024001108","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

背景：确定胫骨平台骨折（TPF）的损伤力机制有助于确定植入物的类型和位置，以及存在风险的软组织。本研究旨在分析胫骨平台骨折的损伤力机制，包括轴向旋转：方法：对 3.5 年内发生的 203 例骨折进行了损伤力机制测定。通过观察CT/MRI上的关节凹陷面积，将骨折分为屈曲-外翻/内翻/中性或（过度）伸展-外翻/内翻/中性。根据Gerdy-胫骨-韧带-外髁-轴（GTT-SEA）角度，将骨折细分为旋转中立型、内旋型或外旋型。如果进行了核磁共振成像，则记录软组织损伤情况：结果：屈曲-瓣膜损伤是最常见的损伤力机制（85人，41.9%），其次是伸展-瓣膜损伤（57人，28.1%）。其他机制较少见（9.4%为伸展-虚脱，5.9%为屈曲-中立，4.9%为屈曲-虚脱，3.9%为过度伸展-虚脱，3.4%为伸展-中立，2.5%为过度伸展-虚脱）。在203名分类患者中，194人（95.6%）可以测量到GTT-SEA角度，其中83人（42.8%）显示内旋，53人（27.3%）显示外旋。受伤机制类型与轴向旋转组（P = 0.964）或旋转范围（H(8) = 7.116，P = 0.524）之间无明显差异。在194例完全分类的骨折中，只有41例（21.1%）接受了核磁共振成像检查，所有检查均显示存在一定程度的软组织损伤。高级别后外侧损伤主要发生在旋转的TPF中：我们的研究结果描述了TPF常见的轴向旋转形式，并探讨了其与损伤力机制和软组织损伤的关系。应用损伤力机制模式和处理旋转力，再加上术前磁共振成像和术中稳定性评估，有助于确定是否需要通过手术处理相关的软组织损伤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Tibiofemoral axial rotation in tibial plateau fractures: A retrospective radiographic assessment of 203 tibial plateau fractures

Background

Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation.

Methods

The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed.

Results

Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (P = 0.964) or extent of rotation (H(8) = 7.116, P = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF.

Conclusion

Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.