胫骨平台后外侧髁“边缘曲线”的影像学研究及临床意义
|
摘要
【目的】研究胫骨平台后外侧髁弧形轮廓的角度及长度,为临床钢板塑形和设计新型水平带状钢板提供理论依据。方法收集50例成人膝关节CT数据[男31例,女19例,平均(37.68±12.76)岁]。在横断面平扫图像下,以腓骨头尖初次显露为标准图片,在胫骨平台外侧髁边缘标记A、B、C、D、E五点。分段测量并记录其连线的长度与夹角,计算后外侧髁曲线长度和曲线的转折角。结果胫骨平台后外侧髁曲线长度平均(44.04±11.33)mm (19.50～75.50 mm),由前向后的三点折弯角平均为(163.36±7.67)°、(127.95±20.85)°和(160.50±11.99)°。手术中按照该测量参数进行钢板折弯与塑形,5例患者术后CT显示,钢板形状与胫骨平台后外侧髁贴服紧密,对皮质轮廓包绕良好。结论按照骨骼测量的边缘曲线参数进行术中钢板折弯和设计新型解剖钢板,能够提高钢板与后外侧髁的贴合程度。
Objective To measure the angles and length of the curve on posterolateral tibial plateau,and to provide theoretical basis for the clinical plate shaping and the design of new horizontal plate.Methods CT data of fifty adult knees were collected(male 31, female 19, mean age 37.68±12.76). Then five points were marked A, B, C, D and E on the edge of posterolateral tibial plateau on the axial CT image when the fibular tip first appeared. The length and angles between each point were measured to provide clinical information on plate length and bending angles. Results The average length of the posterolateral tibial plateau curve was(44.04±11.33)mm(19.50～75.50 mm), and the average turning angles were(163.36±7.67) °,(127.95±20.85) ° and(160.50±11.99) °, from anterior to posterior. Clinically five cases were applied with this anatomic measurement, and the postoperative CT showed that the plate and plateau matched completely and contacted closely. Conclusion Obtaining the marginal curve parameter can facilitate intra-operative bending of horizontal belt plate and design of new types of the anatomical plate to increase compatibility with the shape of the posterolateral tibial plateau.
Objective To measure the angles and length of the curve on posterolateral tibial plateau,and to provide theoretical basis for the clinical plate shaping and the design of new horizontal plate.Methods CT data of fifty adult knees were collected(male 31, female 19, mean age 37.68±12.76). Then five points were marked A, B, C, D and E on the edge of posterolateral tibial plateau on the axial CT image when the fibular tip first appeared. The length and angles between each point were measured to provide clinical information on plate length and bending angles. Results The average length of the posterolateral tibial plateau curve was(44.04±11.33)mm(19.50～75.50 mm), and the average turning angles were(163.36±7.67) °,(127.95±20.85) ° and(160.50±11.99) °, from anterior to posterior. Clinically five cases were applied with this anatomic measurement, and the postoperative CT showed that the plate and plateau matched completely and contacted closely. Conclusion Obtaining the marginal curve parameter can facilitate intra-operative bending of horizontal belt plate and design of new types of the anatomical plate to increase compatibility with the shape of the posterolateral tibial plateau.
引文
[1]Luo CF,Sun H,Zhang B,et al.Three-column fixation for complex tibial plateau fractures[J].J Orthop Trauma,2010,24(11):683-692.
[2]Chang SM,Hu SJ,Zhang YQ,et al.A surgical protocol for bicondylar four-quadrant tibial plateau fractures[J].Int Orthop,2014,38(12):2559-2564.
[3]Chang SM,Hu SJ,Du SC,et al.Four-quadrant/column classification of tibial plateau fractures[J].Int Orthop,2018,42(3):725-727.
[4]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较[J].中国临床解剖学杂志,2015,33(5):497-501.
[5]Huang YG,Chang SM.The posterolateral approach for plating tibial plateau fractures:problems in secondary hardware removal[J].Arch Orthop Trauma Surg,2012,132(5):733-734.
[6]Bermudez CA,Ziran BH,Barrette-Grischow MK.Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures:description and case reports[J].J Trauma,2008,65(5):1162-1167.
[7]Hu SJ,Chang SM,Zhang YQ,et al.The anterolateral supra-fibularhead approach for plating posterolateral tibial plateau fractures:A novel surgical technique[J].Injury,2016,47(2):502-507.
[8]Xiang G,Zhi-Jun P,Qiang Z,et al.Morphological characteristics of posterolateral articular fragments in tibial plateau fractures[J].Orthopedics,2013,36(10):e1256-1261.
[9]Li Q,Zhang YQ,Chang SM.Posterolateral fragment characteristics in tibial plateau fractures[J].Int Orthop,2014,38(3):681-682.
[10]Chang SM,Zheng HP,Li HF,et al.Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J].Arch Orthop Trauma Surg,2009,129(7):955-962.
[11]Yang G,Zhai Q,Zhu Y,et al.The incidence of posterior tibial plateau fracture:an investigation of 525 fractures by using a CT-based classification system[J].Arch Orthop Trauma Surg,2013,133(7):929-934.
[12]高翔,李杭,郑强,等.胫骨后外侧平台骨折的CT形态学研究[J].中华骨科杂志,2014,34(7):709-716.
[13]胡孙君,张英琪,张世民.胫骨平台后外侧骨折的治疗进展[J].中华创伤骨科杂志,2014,16(10):898-901.
[14]Lobenhoffer P,Gerich T,Bertram T,et al.Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures[J].Unfallchirurg,1997,100(12):957-967.
[15]Solomon LB,Stevenson AW,Baird RP,et a1.Posterolateral transfibular approach to tibial plateau fractures:technique results and rationale[J].J Orthop Trauma,2010,24(8):505-514.
[16]Carlson DA.Posterior bicondylar tibial plateau fractures[J].J Orthop Trauma,2005,19(2):73-78.
[17]俞光荣,夏江,周家钤,等.经后外侧入路治疗胫骨平台单纯后外侧骨折[J].中华外科杂志,2010,48(5):390-392.
[18]Cho JW,Samal P,Jeon YS,et al.Rim plating of posterolateral fracture fragments(PLFs)through modified anterolateral approach in tibial plateau fractures[J].J Orthop Trauma,2016,30(11):e362-e368.
[19]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017,41:1887-1897.
[20]孙杰,魏学磊,李方国,等.胫骨平台外侧髁ABC骨折分型及治疗策略[J].中华骨科杂志,2016,36(18):1167-1174.
[21]Giordano V,Schatzker J,Kfuri M.The“Hoop”plate for posterior bicondylar shear tibial plateau fractures:description of a new surgical technique[J].J Knee Surg,2017,30(6):509-513.
[22]Kfuri M,Schatzker J,Castiglia MT,et al.Extended anterolateral approach for complex lateral tibial plateau fractures[J].J Knee Surg,2017,30(3):204-211.
[23]胡孙君,张世民,李双,等.水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究[J].中国临床解剖学杂志,2018,36(1):77-81.
[2]Chang SM,Hu SJ,Zhang YQ,et al.A surgical protocol for bicondylar four-quadrant tibial plateau fractures[J].Int Orthop,2014,38(12):2559-2564.
[3]Chang SM,Hu SJ,Du SC,et al.Four-quadrant/column classification of tibial plateau fractures[J].Int Orthop,2018,42(3):725-727.
[4]胡孙君,张世民,张英琪,等.胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较[J].中国临床解剖学杂志,2015,33(5):497-501.
[5]Huang YG,Chang SM.The posterolateral approach for plating tibial plateau fractures:problems in secondary hardware removal[J].Arch Orthop Trauma Surg,2012,132(5):733-734.
[6]Bermudez CA,Ziran BH,Barrette-Grischow MK.Use of horizontal rafting plates for posterior elements of complex tibial plateau fractures:description and case reports[J].J Trauma,2008,65(5):1162-1167.
[7]Hu SJ,Chang SM,Zhang YQ,et al.The anterolateral supra-fibularhead approach for plating posterolateral tibial plateau fractures:A novel surgical technique[J].Injury,2016,47(2):502-507.
[8]Xiang G,Zhi-Jun P,Qiang Z,et al.Morphological characteristics of posterolateral articular fragments in tibial plateau fractures[J].Orthopedics,2013,36(10):e1256-1261.
[9]Li Q,Zhang YQ,Chang SM.Posterolateral fragment characteristics in tibial plateau fractures[J].Int Orthop,2014,38(3):681-682.
[10]Chang SM,Zheng HP,Li HF,et al.Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J].Arch Orthop Trauma Surg,2009,129(7):955-962.
[11]Yang G,Zhai Q,Zhu Y,et al.The incidence of posterior tibial plateau fracture:an investigation of 525 fractures by using a CT-based classification system[J].Arch Orthop Trauma Surg,2013,133(7):929-934.
[12]高翔,李杭,郑强,等.胫骨后外侧平台骨折的CT形态学研究[J].中华骨科杂志,2014,34(7):709-716.
[13]胡孙君,张英琪,张世民.胫骨平台后外侧骨折的治疗进展[J].中华创伤骨科杂志,2014,16(10):898-901.
[14]Lobenhoffer P,Gerich T,Bertram T,et al.Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures[J].Unfallchirurg,1997,100(12):957-967.
[15]Solomon LB,Stevenson AW,Baird RP,et a1.Posterolateral transfibular approach to tibial plateau fractures:technique results and rationale[J].J Orthop Trauma,2010,24(8):505-514.
[16]Carlson DA.Posterior bicondylar tibial plateau fractures[J].J Orthop Trauma,2005,19(2):73-78.
[17]俞光荣,夏江,周家钤,等.经后外侧入路治疗胫骨平台单纯后外侧骨折[J].中华外科杂志,2010,48(5):390-392.
[18]Cho JW,Samal P,Jeon YS,et al.Rim plating of posterolateral fracture fragments(PLFs)through modified anterolateral approach in tibial plateau fractures[J].J Orthop Trauma,2016,30(11):e362-e368.
[19]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach[J].Int Orthop,2017,41:1887-1897.
[20]孙杰,魏学磊,李方国,等.胫骨平台外侧髁ABC骨折分型及治疗策略[J].中华骨科杂志,2016,36(18):1167-1174.
[21]Giordano V,Schatzker J,Kfuri M.The“Hoop”plate for posterior bicondylar shear tibial plateau fractures:description of a new surgical technique[J].J Knee Surg,2017,30(6):509-513.
[22]Kfuri M,Schatzker J,Castiglia MT,et al.Extended anterolateral approach for complex lateral tibial plateau fractures[J].J Knee Surg,2017,30(3):204-211.
[23]胡孙君,张世民,李双,等.水平带状钢板治疗胫骨平台后外侧象限骨折的生物力学研究[J].中国临床解剖学杂志,2018,36(1):77-81.