| 基于CT的后交叉韧带止点撕脱骨折的三维分型及临床治疗研究 |
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投稿时间：2024-08-27
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| 作者 | Author | 单位 | Address | E-Mail |
| 任广凯 |
REN Guang-kai |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 田宇航 |
TIAN Yu-hang |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 崔铭毓 |
CUI Ming-yu |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 袁宝明 |
YUAN Bao-ming |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 王雁冰 |
WANG Yan-bing |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 彭传刚 |
PENG Chuan-gang |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
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| 李明 |
LI Ming |
宁波市第六医院创伤骨科中心, 浙江 宁波 315040 |
Traumatic Or- thopedics Center, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang, China |
David_abc123@163.com |
| 吴丹凯 |
WU Dan-kai |
吉林大学第二医院骨科医学中心, 吉林 长春 130041 |
Orthopedic Medical Center, the Second Hospital of Jilin University, Changchun 130041, Jilin, China |
wudk@jlu.edu.cn |
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| 期刊信息：《中国骨伤》2025年，第38卷，第4期，第389-395页 |
| DOI：10.12200/j.issn.1003-0034.20240639 |
| 基金项目: |
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中文摘要:
目的: 探讨一种新的基于CT影像特征的后交叉韧带(posterior cruciate ligament,PCL)止点撕脱骨折的三维分型方法及其在临床治疗中的意义。
方法: 回顾性分析2013年5月至2023年11月诊治的43例PCL止点撕脱骨折患者,男29例,女14例,年龄9~63(34.3±8.5)岁。按照传统Meyers和McKeever分型:Ⅰ型3例,Ⅱ型2例,Ⅲ型38例。43例患者基于CT影像特点,制定相应治疗方案,全部患者通过门诊随访收集资料。根据骨折CT影像,并按照骨折移位程度、累及范围及骨折块完整性,初步建立新的PCL止点撕脱骨折三维分型。分型结果采用Kappa系数行一致性检验。
结果: 新的PCL止点撕脱骨折三维分型方法: Ⅰ型,无移位型骨折,其中Ⅰa型为后髁间窝内无移位型;Ⅰb型为超后髁间窝无移位型。Ⅱ型,后髁间窝内移位型骨折,其中Ⅱa型为完整简单型,Ⅱb型为完整分离型,Ⅱc型为粉碎型。Ⅲ型,超后髁间窝移位型骨折,其中Ⅲa型为完整型,Ⅲb型为粉碎型;Ⅲc型为复合型。43例患者按新的PCL止点撕脱骨折三维分型方法: Ⅰa型2例,Ⅰb型1例;Ⅱa型2例,Ⅱb型15例,Ⅱc型7例;Ⅲa型2例,Ⅲb型5例,Ⅲc型9例。43例均获得骨性愈合,末次随访按照美国特种外科医院膝关节评分(Hospital for Special Surgery,HSS)评价分级系统对术后膝关节功能恢复情况:其中优27例,良11例,一般5例。观察者间第1阶段可信度平均Kappa值为0.793,第2阶段为0.855,2个阶段总体平均Kappa值0.839,属于高度一致性;观察者内可信度平均Kappa值为0.893,属于高度一致性。
结论: PCL止点撕脱骨折的三维分型直观明了,有较高的可信度,对临床治疗方法的选择具有一定的指导意义。 |
| 【关键词】计算机断层扫描 后交叉韧带 止点撕脱骨折 三维分型 临床治疗 |
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| Three dimensional classification and clinical treatment of posterior cruciate ligament tibial avulsion fracture based on CT |
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ABSTRACT
Objective A new three dimensional (3D) classification of posterior cruciate ligament (PCL) tibial avulsion fracture based on computed tomography(CT) features was established and the significance in clinical treatment was explored in this study.
Methods From May 2013 to November 2023,43 cases of PCL tibial avulsion fracture in the Second Hospital of Jilin University were analyzed retrospectively,including 29 males and 14 females,aged (34.3±8.5) years. According to traditional Meyers and McKeever classification,3 cases were typeⅠ;2 cases of typeⅡ;38 cases were type Ⅲ. Based on the characteristics of CT images,43 patients were given specific treatment strategies and followed up to evaluate the curative effect. According to the degree of fracture displacement,involved range and the integrity of fracture block demonstrated by CT images,the new three dimensional classification of PCL avulsion fracture was established. Kappa coefficient was used for consistency test.
Results A new 3D classification of PCL tibial avulsion fracture was established. TypeⅠwas the non displaced fracture (displacement degree ≤ 3 mm),in which typeⅠa was the avulsion range limited in the posterior intercondylar fossa,and Ib was the avulsion range beyond the posterior intercondylar fossa. TypeⅡrepresented the displaced fracture in the posterior intercondylar fossa (avulsion limited to the posterior intercondylar fossa and fracture displacement>3 mm),in which typeⅡa represented a slight displacement with a intact broken block and the posterior elevation of the avulsion (hinge mechanism),typeⅡb represented the complete separation of fracture ends with a intact fracture block,and typeⅡc was the comminuted fracture. Type Ⅲ was the displaced fracture beyond the posterior intercondylar fossa (avulsion involving the articular surface of the tibial plateau or the intercondylar ridge and the degree of displacement > 3 mm),among which type Ⅲa was the simple fracture with intact broken block,type Ⅲb represented the comminuted fracture,and type Ⅲc was the complex fracture with tibial plateau fracture. According to this new 3D classification,43 patients were classified as type Ia in 2 cases and typeⅠb in 1 case;typeⅡa in 2 cases,typeⅡb in 15 cases and typeⅡc in 7 cases;type Ⅲa in 2 cases,type Ⅲb in 5 cases and type Ⅲc in 9 cases. All the 43 cases in this study achieved bone union. At the last follow up,according to the hospital for special surgery knee score(HSS)evaluation system for the knee joint function,27 cases were excellent,11 cases were good,5 cases were fair. The average Kappa value of inter observer reliability in the first stage was 0.793,and the second stage was 0.855. The average Kappa value of the whole stage was 0.839,indicating high level of consistency. The average Kappa value of intra observer reliability was 0.893,indicating high level of consistency.
Conclusion The 3D classification of PCL tibial avulsion fracture is intuitive,demonstrating a high level of reliability. It has a certain guiding significance for the selection of clinical treatment methods,and it is suggested to be promoted and applied as a new classification system in clinical practice. |
| KEY WORDS Computed tomography Posterior cruciate ligament Tibial avulsion fracture Three dimensional classification Clinical treatment |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 任广凯,田宇航,崔铭毓,袁宝明,王雁冰,彭传刚,李明,吴丹凯.基于CT的后交叉韧带止点撕脱骨折的三维分型及临床治疗研究[J].中国骨伤,2025,38(4):389~395 |
| 英文格式: | REN Guang-kai,TIAN Yu-hang,CUI Ming-yu,YUAN Bao-ming,WANG Yan-bing,PENG Chuan-gang,LI Ming,WU Dan-kai.Three dimensional classification and clinical treatment of posterior cruciate ligament tibial avulsion fracture based on CT[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(4):389~395 |
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