Imaging Features and Clinical Significance of Segond Fracture
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摘要: 目的：评价Segond骨折的影像学特征并探讨其在膝关节外侧不稳中的临床应用价值。方法：回顾性分析45例临床影像诊断为胫骨平台外缘撕脱骨折（Segond骨折）的病例，分析骨折的特点，包括骨折与膝关节周围韧带、半月板损伤的关系、骨折块的大小、位置，探讨Segond骨折对临床治疗的意义。结果：45例Segond骨折中有41例（91.11％）合并前交叉韧带（ACL）损伤，31例（68.89％）合并前外侧韧带（ALL）损伤，12例（26.67％）合并髂胫束（ITB）损伤。ALL全部附着于骨折块上，ITB附着25例（55.55％）。骨折块体积越大、与Gerdy结节中心的距离越小，ITB附着折块的可能性就越大。结论：Segond骨折常合并ACL损伤、累及ALL、ITB，骨折块越大、距Gerdy结节中心越近累及ITB的可能性就越大，Segond骨折患者应警惕膝关节外侧不稳。Abstract: Objective: To evaluate the imaging features of Segond fracture and explore its clinical value in lateral instability of the knee joint. Methods: Retrospectively analyze 45 cases of Segond fracture. Analyze the characteristics of the fracture, included the relationship between the fracture and the ligaments around the knee joint, meniscus injury, the size and location of the fracture block. The significance of Segond fracture in clinical treatment was discussed. Results: Among 45 cases of Segond fracture, 41 cases (91.11%) had anterior cruciate ligament (ACL) injury, 31 cases (68.89%) had anterolateral ligament (ALL) injury, and 12 cases (26.67%) had iliotibial bundle (ITB) injury. ALL were all attached to the fracture block, and 25 cases (55.55%) were attached to the ITB. The larger the size of the fracture block and the smaller the distance from the center of Gerdy's nodule, the more likely the fracture block will be attached to the ITB. Conclusion: Segond fracture is often associated with ACL injury, involving ALL and ITB. The larger the fracture block and the closer to the center of Gerdy's nodule, the greater the possibility of involving ITB. Patients with Segond fracture should be alert to lateral instability of the knee joint.
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Key words:
- knee joint /
- anterolateral ligament /
- injury /
- magnetic resonance imaging
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图 1 男，35岁，右胫骨平台外侧缘撕脱骨折
膝关节CT平扫横断面（a）及冠状面MPR（b），示右胫骨平台外侧缘可见撕脱小骨块体积0.04 cm3（0.59 cm×0.11 cm×0.56 cm），距Gerdy结节距离约2.02 cm。（c）～（d），冠状面脂肪抑制TSE PDWI，（c）显示ALL附着于骨折块上并水肿（箭）。（d）显示ITB未见明显异常（箭）。
Figure 1. Male, 35 years old, avulsion fracture of the lateral edge of the right tibial plateau
图 2 Segond骨折块大小、体积、距Gerdy结节及关节面距离与ITB附着的ROC曲线
Figure 2. ROC curve of Segond fracture block size, volume, distance from Gerdy nodule and articular surface to ITB attachment
图 3 男，51岁，左胫骨外侧平台撕脱骨折
膝关节CT平扫横断面（a）及冠状面MPR（b），显示右胫骨平台外侧缘可见撕脱小骨块体积0.07 cm3（0.92 cm×0.11 cm×0.70 cm），距Gerdy结节距离约0.72 cm。（c）～（d），冠状面脂肪抑制TSE PDWI。（c）显示ALL（长箭）及ITB（短箭）附着骨折块上，韧带未见明显损伤。（d）显示ITB附着点水肿（细箭），内侧副韧带损伤（粗箭）。
Figure 3. Male, 51 years old, avulsion fracture of left lateral tibial plateau
表 1 Segond骨折合并韧带、半月板损伤（例％）
Table 1. Segond Fracture with Ligament and Meniscus Injury （％）
影像表现 ACL ALL ITB PCL LCL MCL MM* ML* 撕裂 19（42.22） 2（4.44） 0 0 2（4.44） 10（22.22） 8（17.77） 9（20.00） 水肿 22（48.89） 29（64.44） 12（26.67） 5（11.11） 24（53.33） 25（55.56） 11（24.44） 7（15.56） 正常 4（8.89） 14（31.11） 33（73.33） 40（88.89） 19（42.22） 20（44.44） 26（57.78） 19（42.22） 注：ALL:前外侧韧带，ITB:髂胫束，ACL:前交叉韧带，PCL:后交叉韧带，LCL:外侧副韧带，MCL:内侧副韧带，MM:内侧半月板，
ML:外侧半月板。*半月板损伤Ⅲ度以上归为撕裂、Ⅰ度、Ⅱ度为水肿。
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表 2 Segond骨折块的大小、位置与附着韧带的关系
Table 2. The relationship between the size and position of Segond fracture block and the attached ligament
Segond骨折块 ALL（n=45） ITB（n=25） 统计检验 Z P D前后/cm 1.05±0.37 1.38±3.3 -2.73 0.006 D左右/cm 0.62±0.19 0.73±0.15 -1.69 0.090 D上下/cm 0.28±0.08 0.36±0.08 -0.31 0.002 D/cm3 0.19±0.12 0.36±0.13 -4.16 ＜0.001 D距Gerdy结节/cm 0.90±0.23 0.64±0.16 -3.39 0.001 D距关节面/cm 0.21±0.11 0.20±0.12 -0.89 0.370
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