Department of Orthopedic Surgery, University of Louisville, 210 E. Gray Street, Ste. 1003, Louisville, KY 40202, USA.
J Orthop Traumatol. 2012 Jun;13(2):89-95. doi: 10.1007/s10195-012-0185-z. Epub 2012 Mar 6.
Anatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce these fracture patterns. The concept is built on the success of the tamp in kyphoplasty of the spine, but it has yet to be tested in the lab for use in the extremities. We performed an investigation into the safety and efficacy of using an inflatable bone tamp for intra-articular fracture reduction of the tibial plateau and distal radius.
Paired cadaveric specimens were obtained for a total of six proximal tibias and six distal radii. Intra-articular depression-type fractures were created in all specimens. The inflatable bone tamp was then used to reduce the depression. For comparison, the tibias were fractured on the medial and lateral side and a conventional metal tamp was used on the contralateral side of the balloon. Fine-cut micro-computed tomography (CT) scans were performed on all intact specimens, which were then fractured, and again after fracture reduction. CT data was used to measure the amount of restoration of the normal anatomy and to compare the effectiveness of the balloon to conventional methods.
The inflatable bone tamp was equivalent to conventional methods in large, minimally displaced fracture fragments and proved superior when comminution was present at the articular surface. No instances of overreduction or penetration into the joint were encountered with the balloon, whereas this was a common occurrence with conventional metal tamps. The inflatable tamp was successful in reducing all distal radius fractures without complication.
Anatomic reduction of impacted articular fractures should be the goal of any treating surgeon. In our cadaveric models, we have shown the inflatable bone tamp to be safe and effective in reducing depressed articular fractures around the tibial plateau and distal radius. The balloon offers the advantage of being minimally invasive and creating a symmetric, contained defect to hold bone filler for subchondral support.
关节内胫骨平台和桡骨远端骨折的解剖复位可能很困难。治疗目标集中在恢复原生解剖结构和关节一致性上。美国的几位外科医生已经开始使用充气骨压块来复位这些骨折模式。该理念基于在脊柱后凸成形术中压块的成功，但尚未在实验室中对其在四肢中的应用进行测试。我们对使用充气骨压块复位关节内胫骨平台和桡骨远端骨折的安全性和有效性进行了研究。
总共获得了 6 个胫骨近端和 6 个桡骨远端的成对尸体标本。所有标本均形成关节内凹陷型骨折。然后使用充气骨压块来复位凹陷。为了比较，胫骨在内侧和外侧骨折，对侧使用传统金属压块。对所有完整标本进行精细切割微计算机断层扫描（CT）扫描，然后进行骨折，再进行骨折复位后进行扫描。使用 CT 数据测量正常解剖结构恢复的程度，并比较球囊与传统方法的有效性。
充气骨压块在大的、轻度移位的骨折碎片中与传统方法等效，在关节表面存在粉碎性骨折时效果更好。在使用球囊时，没有出现过度复位或穿透关节的情况，而这在使用传统金属压块时很常见。充气压块成功复位了所有桡骨远端骨折，无并发症发生。
任何治疗外科医生的目标都应该是实现关节内骨折的解剖复位。在我们的尸体模型中，我们已经证明充气骨压块在复位胫骨平台和桡骨远端周围凹陷性关节骨折时是安全有效的。球囊的优点是微创，并形成对称的、包含的缺陷，以容纳骨填充物以提供软骨下支撑。
