| 董方.术前MSCT用于预测胫骨平台骨折内固定术中半月板损伤的价值[J].安徽医药,待发表. |
| 术前MSCT用于预测胫骨平台骨折内固定术中半月板损伤的价值 |
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| 投稿时间：2023-04-20 录用日期：2023-05-25 |
| DOI： |
| 中文关键词: 多层螺旋CT 胫骨平台骨折 术中半月板损伤 预测 |
| 英文关键词: |
| 基金项目:山东省医药卫生科技发展计划项目2019WS106 |
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| 中文摘要: |
| 目的：探讨术前多层螺旋CT(MSCT)用于预测胫骨平台骨折内固定术中半月板损伤的价值。方法：回顾2017年1月至2022年12月我院收治的83例拟行胫骨平台骨折内固定术治疗患者的临床资料,术前均接受MSCT检查,以术中骨折复位内固定后即刻关节镜下所见有无发生半月板损伤为金标准分为损伤组和无损伤组。比较两组患者基线资料及MSCT参数,采用多因素Logistic回归分析法明确术中发生半月板损伤的危险因素,绘制受试者工作特征(ROC)曲线分析MSCT参数对复杂胫骨平台骨折内固定术中半月板损伤的预测价值。结果：83例胫骨平台骨折患者术中发生半月板损伤共39例(46.99%),经c2检验,Ⅳ型半月板损伤发生率低于其他分型(P＜0.05)。损伤组中Schatzker Ⅱ型占比高于无损伤组,Schatzker Ⅳ型占比及术前MSCT检测骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积高于低于无损伤组(P＜0.05)。多因素Logistic回归分析结果显示,骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积均是胫骨平台骨折内固定术中半月板损伤的危险因素(P＜0.05)。ROC曲线分析显示,骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积单独及联合应用预测胫骨平台骨折内固定术中半月板损伤的AUC(95%CI)为0.643(0.557~0.725)、0.704(0.618~0.780)、0.755(0.673~0.826)、0.890(0.831~0.942),联合应用的预测价值高于单独预测(P＜0.05)。结论：术前MSCT测量胫骨平台骨折外侧髁切线至骨折块远端距离、塌陷相对面积等参数对预测内固定术中半月板损伤有重要参考价值。 |
| 英文摘要: |
| Objective To investigate the value of preoperative multilayer spiral CT (MSCT) for predicting meniscal injury during internal fixation of tibial plateau fractures. Methods The clinical data of 83 patients admitted to our hospital from January 2017 to December 2022 who were proposed to be treated with internal fixation of tibial plateau fractures were reviewed. All patients underwent MSCT examination before surgery, and were divided into injury and non-injury groups based on the gold standard of whether meniscal injury occurred as seen arthroscopically immediately after intraoperative fracture reduction and internal fixation. Baseline data and MSCT parameters were compared between the two groups. Multi-factor logistic regression analysis was used to identify the risk factors for intraoperative meniscal injury. To analyse the predictive value of MSCT parameters for meniscus injury during internal fixation of complex tibial plateau fractures by plotting subject work characteristic (ROC) curves. Results Intraoperative meniscal injury occurred in a total of 39 (46.99%) of 83 patients with tibial plateau fractures, and the incidence of type IV meniscal injury was lower than other subtypes by c2 test (P < 0.05). The percentage of Schatzker type II was higher in the injury group than in the no-injury group, and the percentage of Schatzker type IV, the distance from the fracture tangent line to the lowest point of collapse, the distance from the lateral condyle tangent line to the distal end of the fracture block, and the relative area of collapse detected by preoperative MSCT were higher than those in the no-injury group (P < 0.05). Multi-factor logistic regression analysis showed that fracture tangent line to collapse nadir distance, lateral condyle tangent line to distal fracture block distance, and relative area of collapse were all risk factors for meniscal injury during internal fixation of tibial plateau fractures (P < 0.05). ROC curve analysis showed that the AUC (95% CI) for fracture tangent line to nadir of collapse distance, lateral condyle tangent line to distal fracture block distance, and relative area of collapse alone and in combination to predict meniscal injury during internal fixation of tibial plateau fractures was 0.643 (0.557-0.725), 0.704 (0.618-0.780), 0.755 (0.673-0 0.826), and 0.890 (0.831-0.942), with the predictive value of the combined application being higher than that predicted alone (P < 0.05). Conclusion Preoperative MSCT measurements of the distance from the lateral condyle tangent line to the distal end of the fracture block and the relative area of collapse of the tibial plateau fracture are important reference values for predicting intraoperative meniscal injury during internal fixation. |
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