胫骨结节骨折和髌腱损伤的标志是胫骨结节矢状骨折旋转和奥格登I型分类。

Rebecca J Schultz,Jason Z Amaral,Matthew J Parham,Raymond L Kitziger,Tiffany M Lee,Scott D McKay,Basel M Touban
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摘要

背景胫骨结节骨折(TTF)是一种不常见的损伤,占所有胫骨近端骨折的<3%。这些骨折偶尔会与髌腱损伤(PTI)同时发生。我们旨在确定与合并 TTF 和 PTI 相关的风险因素。方法我们对 2012 年至 2023 年期间在一家三级儿童医院就诊的 TTF 患者进行了回顾性研究。对人口统计学数据、手术细节、X光片和损伤模式进行了分析。对X光片的骺板结合阶段(EUS)、奥格登分类和骨折模式进行了评估。采用多元逻辑回归模型评估体重指数、粉碎程度、骨折片旋转、EUS、双侧损伤和奥格登分类对损伤类型的影响。其中 6% 为女性,48% 为黑人。在262例骨折中,228例(87%)为孤立的TTF,34例(13%)为伴有PTI的TTF。多变量分析表明,侧位X光片上的碎片旋转(p < 0.0001)和奥格登I型分类(p < 0.0001)是最能预测合并损伤的风险因素。旋转与合并损伤几率的大幅增加有关,几率比为 22.1(95% 置信区间 [CI],6.1 至 80.1)。结论奥格登I型骨折是另一个重要的风险因素,其几率比为10.2(95% CI,3.4至30.4)。这是第一项确定TTF合并PTI风险因素的研究。外科医生可利用这一信息帮助制定术前计划。有关证据级别的完整描述,请参阅 "作者须知"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sagittal Fragment Rotation and Ogden Type-I Classification Are Hallmarks of Combined Tibial Tubercle Fracture and Patellar Tendon Injury.
BACKGROUND Tibial tubercle fractures (TTFs) are uncommon injuries, comprising <3% of all proximal tibial fractures. These fractures occasionally occur in conjunction with a patellar tendon injury (PTI). We aimed to identify risk factors associated with combined TTF and PTI. METHODS A retrospective review was performed of patients presenting to a single, tertiary children's hospital with TTF between 2012 and 2023. Demographic data, operative details, radiographs, and injury patterns were analyzed. Radiographs were assessed for the epiphyseal union stage (EUS), Ogden classification, and fracture patterns. Multiple logistic regression models were used to assess the impact of body mass index, comminution, fracture fragment rotation, EUS, bilateral injury, and Ogden classification on injury type. RESULTS We identified 262 fractures in 252 patients (mean age, 13.9 ± 1.31 years). Of the patients, 6% were female and 48% were Black. Of the 262 fractures, 228 (87%) were isolated TTFs and 34 (13%) were TTFs with PTI. Multivariable analysis demonstrated fragment rotation on lateral radiographs (p < 0.0001) and Ogden Type-I classification (p < 0.0001) to be the most predictive risk factors for a combined injury. Rotation was associated with a substantial increase in the odds of a combined injury, with an odds ratio of 22.1 (95% confidence interval [CI], 6.1 to 80.1). Ogden Type-I fracture was another significant risk factor, with an odds ratio of 10.2 (95% CI, 3.4 to 30.4). CONCLUSIONS The Ogden classification and fragment rotation are the most useful features for distinguishing between isolated TTF and combined TTF with PTI. This is the first study to identify risk factors for TTF combined with PTI. Surgeons may use this information to aid in preoperative planning. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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