如何通过术前影像，判断胫骨平台骨折半月板损伤情况？
骨折术前常规CT检查，对胫骨平台平台骨折，能否通过术前CT骨折表现，预测半月板损伤情况？
国外学者进行了相关研究，对比不同类型平台骨折半月板损伤的概率，取得了阳性结果。
Objectives（目的）
[Objectives: There is limited data regarding meniscal injury and it’s association to fracture location and articular impaction/displacement (AID) in tibial plateau fractures. The purpose of this study was to predict lateral meniscal injury in tibial plateau fractures, based on location and extent of AID as visualized on preop CT images.]
Patients（病例）
[Patients: We retrospectively reviewed lateral tibia plateau fracture patients that were treated operatively using CPT codes 27535 and 27536. Two hundred patients were identified. Inclusion criteria were lateral tibia plateau fracture, age of 18 years or older, and documented direct examination of lateral meniscus integrity intraoperatively. Seventy patients met inclusion criteria.]
Intervention（干预）
依据术前CT将损伤的胫骨外侧平台分为四个象限，并测量最大AID。骨折区域被定义为最大AID的位置(图1)。所有患者在手术时都进行了关节切开术，以评估半月板的完整性。对术中有关半月板完整性的数据和术前CT数据进行分析。Logistic回归被用来估计何种骨折区和AID数值有助于预测半月板损伤。进行接受者操作特征曲线(ROC)分析，以确定高敏感性/特异性的截止点。
[Intervention:The injured lateral tibial plateau was divided into four quadrants on pre-operative CT and maximum AID was measured. The zone of fracture was defined as the location of largest AID (Image-1). All patients had an arthrotomy at the time of surgery to evaluate the integrity of the meniscus. Intraoperative data regarding meniscal integrity and preoperative CT data were analyzed. Logistic regression was used to estimate what effect zone and amount of AID had on predicting the meniscal injury. Receiver operating characteristic (ROC) analysis was performed to determine cut off points for high sensitivity/specificity.]
图1：外侧平台的四象限划分。
图2：AID定义为关节面切线，与经塌陷最低点关节面平行线的距离。AID所在象限为骨折累及部位。
Results（结果）
平均年龄(45.1±12.9)岁，12例为Schatzker I型骨折，58例为II型骨折。22名患者有半月板损伤（meniscus injury，MI），48名患者没有半月板损伤（NMI）。MI患者平均AID为12.48±7.17mm，NMI组为6.4±4.3mm(p<0.01)。MI组中，最大的AID位于后外侧区(17.58±8.9mm)，其次是前内侧区(13.3±7.2mm)和前外侧区(9.4±5.8mm)。在NMI组中，最大的AID在前外侧区(8.52±2.6mm)，其次是前内侧区(8.04±5.4mm)和后外侧区(7.75±2.35mm)。与其他区域相比，后外侧区骨折合并半月板撕裂发生率较低。Logistic回归显示，AID每增加1毫米，半月板撕裂的几率增加21%(p < 0.01)。区域的比较表明，对于相同的AID，与后外侧区域相比，前外侧和前内侧区域骨折半月板撕裂的风险分别增加了7.3倍和5.6倍(p<0.05)。ROC分析显示，以4.3 mm作为切点的AID对半月板撕裂的诊断具有100%的敏感性。
[Results: Mean age was (45.1 ± 12.9) years. Twelve had Schatzker type I and 58 had type II fractures. Twenty-two patients had meniscus injury (MI) and forty-eight patients did not have a meniscus injury (NMI). Mean AID for MI was 12.48 mm ± 7.17 mm and 6.4 mm ± 4.3 mm for NMI (p<0.01). In MI group, largest AID was in Posterolateral (PL) zone(17.58 mm ± 8.9 mm) followed by Anteromedial (AM) zone (13.3 mm ± 7.2 mm) and Anterolateral (AL) zone (9.4 mm ± 5.8 mm). In NMI group largest AID was in AL zone (8.52 mm ± 2.6 mm) followed by AM zone (8.04 mm ± 5.4 mm) and PL zone (7.75 mm ± 2.35 mm). Patients with PL zone involvement had a lower meniscus tear rate compare to other zones. Logistic regression revealed that for every 1 mm increase in AID there is a 21% increase chance of meniscus tear (p<0.01). Comparison of the zones indicated that for the same AID, AL and AM zone fractures have 7.3 and 5.6 times increase risk of meniscus tear, respectively, as compared to PL zone (p<0.05). ROC analysis revealed that AID of 4.3 mm as a cut off point provides 100% sensitivity for diagnosis of meniscus tear.]
表1：受伤机制。
表2：半月板损伤与非半月板损伤组的AID值。
表3：半月板损伤与非半月板损伤组各骨折部位的AID值。
表4：各骨折象限合并半月板损伤的概率。
Conclusion（结论）
[Conclusion: With 1 mm increase in AID there is a 21% increase in chance of meniscal tear. With the same AID, AL and AM zone fractures have a significantly higher chance of having a meniscal tear. AID of 4.3 mm provides 100% sensitivity to predict meniscal tear in lateral tibia plateau fracture. These values are useful in predicting pre op meniscal tear without MRI.]
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