Segond 骨折发生在胫骨平台上最低的入点下骨小梁骨体积分数的部位。,Journal of Anatomy

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Segond 骨折发生在胫骨平台上最低的入点下骨小梁骨体积分数的部位。
Journal of Anatomy ( IF 1.8 ) Pub Date : 2020-08-08 , DOI: 10.1111/joa.13282
William Mullins ₁ , Gavin E Jarvis ₁ , Daniel Oluboyede ₁ , Linda Skingle ₂ , Ken Poole ₂ , Tom Turmezei ₃ , Cecilia Brassett ₁

Affiliation

在一系列人体尸体实验中，Paul Segond 博士首先描述了发生在胫骨前外侧平台的撕脱伤，后来以他的名字命名。骨折被认为是由于胫骨过度内旋引起的，这通常也会引起膝关节其他结缔组织的损伤。然而，撕脱背后的确切机制尚不清楚。在单独的研究中已经提出了许多韧带结构以插入 Segond 片段。建议包括髂胫束（ITB）、股二头肌和有争议的“前外侧韧带”（ALL）。尽管对健康和疾病状态下胫骨平台骨微结构的了解越来越多，但据我们所知，还没有研究考虑胫骨附着点下骨结构在 Segond 骨折发病机制中的作用。因此，本研究的目的是阐明胫骨平台区域小梁特性的差异，以便解释前外侧区域对撕脱伤的敏感性。使用 Nikon-XTH225-μCT 扫描仪对来自尸体供体的 20 个人类胫骨平台进行解剖和成像，各向同性体素尺寸小于 80 μm。使用 MicroView 3D 图像查看器和分析工具重建扫描。随后在 10 个解剖学定义的感兴趣区域 (ROI) 进行的虚拟活检生成了骨体积分数的估计值（“骨体积除以总体积”（BV/TV））。所有 20 条胫骨和所有 10 条 ROI 的总体平均 BV/TV 值为 0.271。单变量重复测量方差分析表明，ROI 之间的 BV/TV 值不同。Segond 站点的 BV/TV 值 (Sα, Sβ 或 Sγ) 分别低于所有其他 ROI，为 0.195、0.192 和 0.193。这表明，尽管样本间和样本内存在差异，但 Segond 部位的骨小梁体积分数往往低于胫骨其他部位的附着点。由于 BV/TV 与拉伸和扭转强度相关，Segond 部位的较低 BV/TV 可能等同于某些个体的局部虚弱区域，这使他们在过度内旋施加力后容易发生撕脱伤。在 Segond 站点记录的低 BV/TV 也挑战了骨折是由于从离散的“前外侧韧带”拉扯而发生的想法，因为预计局部施加的张力会引起肥大反应，符合 Frost 的机械恒压器假设。

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The Segond fracture occurs at the site of lowest sub-entheseal trabecular bone volume fraction on the tibial plateau.

In a series of human cadaveric experiments, Dr. Paul Segond first described the avulsion injury occurring at the anterolateral tibial plateau that later took his name. The fracture is thought to arise as a consequence of excessive tibia internal rotation which often also elicits damage to other connective tissue of the knee. The exact mechanism behind the avulsion is, however, unclear. A number of ligamentous structures have been proposed in separate studies to insert into the Segond fragment. Suggestions include the iliotibial band (ITB), biceps femoris and the controversial ‘anterolateral ligament’ (ALL). Despite increasing knowledge of tibial plateau bony microarchitecture in both healthy and disease states, no studies have yet, to our knowledge, considered the role of tibial sub‐entheseal bone structure in pathogenesis of the Segond fracture. The goal of this study was thus to elucidate the differences in trabecular properties at regions across the tibial plateau in order to provide an explanation for the susceptibility of the anterolateral region to avulsion injury. Twenty human tibial plateaus from cadaveric donors were dissected and imaged using a Nikon‐XTH225‐μCT scanner with <80 μm isotropic voxel size. Scans were reconstructed using MicroView 3D Image Viewer and Analysis Tool. Subsequent virtual biopsy at ten anatomically defined regions of interest (ROI) generated estimates of bone volume fraction (‘bone volume divided by total volume’ (BV/TV)). The overall mean BV/TV value across all 20 tibiae and all 10 ROIs was 0.271. Univariate repeated‐measurements ANOVA demonstrated that BV/TV values differed between ROIs. BV/TV values at the Segond site (Sα, Sβ or Sγ) were lower than all other ROIs at 0.195, 0.192 and 0.193, respectively. This suggests that, notwithstanding inter‐ and intra‐specimen variation, the Segond site tends to have a lower trabecular bone volume fraction than entheseal sites elsewhere on the tibia. Since BV/TV correlates with tensile and torsional strength, the lower BV/TV at the Segond site could equate to a region of local weakness in certain individuals which predisposes them to an avulsion injury following the application of force from excessive internal rotation. The low BV/TV recorded at the Segond site also challenges the idea that the fracture occurs due to pull from a discrete ‘anterolateral ligament’, as the tension exerted focally would be expected to elicit a hypertrophic response in line with Frost's Mechanostat hypothesis. Our data would instead agree with the aforementioned reports of the fibrous band at the Segond site being part of a broader insertion of an ‘anterolateral complex’.

更新日期：2020-08-08

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