骨科英文书籍精读（336）｜胫骨平台骨折分型
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TIBIAL PLATEAU FRACTURES
Mechanism of injury
Fractures of the tibial plateau are caused by a varus or valgus force combined with axial loading (a pure valgus force is more likely to rupture the ligaments). This is sometimes the result of a car striking a pedestrian (hence the term 'bumper fracture’); more often it is due to a fall from a height in which the knee is forced into valgus or varus. The tibial condyle is crushed or split by the opposing femoral condyle, which remains intact.
Pathological anatomy
The fracture pattern and degree of displacement depend on the type and direction of force as well as the quality of the bone at the upper end of the tibia. A useful classification is that of Schatzker (Fig. 30.17):
Type 1 – a vertical split of the lateral condyle
This is a fracture through dense bone, usually in younger people. It may be virtually undisplaced, or the condylar fragment may be pushed inferiorly and tilted; the damaged lateral meniscus may be trapped in the crevice.
Type 2 – a vertical split of the lateral condyle combined with depression of an adjacent loadbearing part of the condyle
The wedge fragment, which varies in size from a portion of the rim to a sizeable part of the lateral condyle, is displaced laterally; the joint is widened and, if the fracture is not reduced, may later develop a valgus deformity.
Type 3 – depression of the articular surface with an intact condylar rim
Unlike type 2, the split to the edge of the lateau is absent. The depressed fragments may be wedged firmly into the subchondral bone. The joint is usually stable and may tolerate early movement.
Type 4 – fracture of the medial tibial condyle
Two types of fracture are seen: (1) a depressed, crush fracture of osteoporotic bone in an elderly person (a low-energy lesion), and (2) a high-energy fracture resulting in a condylar split that runs obliquely from the intercondylar eminence to the medial cortex. The momentary varus angulation may be severe enough to cause a rupture of the lateral collateral ligament and a traction injury of the peroneal nerve. The severity of these injuries should not be underestimated.
Type 5 – fracture of both condyles
Both condyles are split but there is a column of the metaphysis wedged in between that remains in continuity with the tibial shaft.
Type 6 – combined condylar and subcondylar fractures
This is a high-energy injury that may result in severe comminution. Unlike type 5 fractures, the tibial shaft is effectively disconnected from the tibial condyles.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
plateau/plæˈtoʊ/n. 高原；稳定水平；托盘；平顶女帽vi. 达到平衡；达到稳定时期
tibial plateau胫骨平台
bumper fracture车撞骨折
bumper /ˈbʌmpər/n. 保险杠；满杯；（板球）反弹球；新马平地赛；广告时段；大满杯敬酒；（非正式）烟头adj. 丰盛的；巨大的；首尾相接的v. 满杯祝酒；干杯；装满
It may be virtually undisplaced,可能没有移位
the damaged lateral meniscus may be trapped in the crevice受损的外侧半月板可能困在裂隙中
meniscus /məˈnɪskəs/n. [解剖] 半月板；弯月面；新月形物
crevice /ˈkrevɪs/n. 裂缝；裂隙
wedge fragment楔形骨块
wedge /wedʒ/n. 楔子；楔形物；不和v. 楔入；挤进；楔住
obliquely /əˈbliːkli/adv. 倾斜地；转弯抹角地
intercondylar eminence髁间隆起
peroneal nerve腓总神经
/,perə'ni:əl/adj. 腓骨的；腓侧的
有道翻译（仅供参考，建议自己翻译）：
胫骨平台骨折
损伤机制
胫骨平台骨折是由内翻或外翻力和轴向载荷共同作用造成的（单纯外翻力更容易使韧带断裂）。这有时是由于汽车撞到行人（因此称为“保险杠骨折”）；更常见的是由于从某个高度坠落，膝盖被迫外翻或内翻。胫骨髁被相对的股骨髁压碎或撕裂，股骨髁保持完整。
病理解剖学
骨折类型和移位程度取决于力的类型和方向以及胫骨上端的骨质量。一个有用的分类是Schatzker（图30.17）：
1型-外侧髁的垂直裂开这是一种穿过致密骨的骨折，通常发生在年轻人身上。髁突可能几乎没有移位，或者髁突碎片可能被推到下方并倾斜；受损的外侧半月板可能卡在缝隙中。
2型–外侧髁的垂直分裂与相邻承载部分髁状突的凹陷相结合楔形碎片，其大小从边缘的一部分到外侧髁的相当大的一部分不等，横向移位；关节变宽，如果骨折没有减少，以后可能会出现外翻畸形。
3型-关节面凹陷，髁突边缘完整。与2型不同，髁突边缘无裂口。凹陷的碎片可以牢固地楔入软骨下骨。关节通常是稳定的，可以承受早期运动。
4型-胫骨内侧髁骨折两种类型的骨折：（1）老年人骨质疏松性骨凹陷粉碎性骨折（低能量损伤），和（2）高能量骨折导致髁状突从髁间隆起向内侧皮质倾斜。瞬间内翻角度可能严重到足以导致外侧副韧带断裂和腓神经牵拉损伤。这些伤害的严重程度不应低估。
5型-双髁骨折-双髁分离，但中间有一根干骺端，与胫骨干保持连续性。
6型-髁突和髁下联合骨折这是一种可能导致严重粉碎的高能损伤。与5型骨折不同，胫骨干与胫骨髁有效断开。