Khan Humza, Grob Karl, Milne Lachlan Peter, Kuster Markus Stefan
Royal Perth Hospital, Western Australia, Australia.
Department of Orthopaedic Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, St. Gallen CH-9007, Switzerland.
Injury. 2016 Oct;47(10):2331-2338. doi: 10.1016/j.injury.2016.03.027. Epub 2016 May 4.
Adequate exposure is fundamental to safely and correctly perform open procedures around the knee. Tibial tubercle osteotomy (TTO) has previously been described as a method to improve exposure, particularly in complex primary elective knee arthroplasty or revision surgery. We describe a tibial tubercle osteotomy technique to improve exposure in complex knee fractures and a cadaveric study and trauma case series.
A cadaveric study using 8 knee specimens was conducted using a lateral subvastus approach to the knee. Standardised pictures were taken of the exposure, the tibial tubercle osteotomy was performed and pictures were taken of the new exposed area. These images were compared using a computer program that calculated the area of exposure before and after tibial tubercle osteotomy and the results analysed. The technique was then used in a case series of 6 different complex knee fractures including three distal femoral, one periprosthetic distal femur and two tibial plateau fractures. The outcomes of these patients were followed clinically and radiologically.
All specimens in the cadaveric study demonstrated an increase in area of exposure after the TTO with a mean increase of 148%. All tibial tubercle osteotomies performed in the trauma case series were united by 6 months without complication.
Tibial tubercle osteotomy is a recognised technique for improving exposure to the knee. This has been demonstrated in a cadaveric study and in a case series of six complex fractures around the knee. If performed properly, this technique can be extended to appropriate trauma cases with good results.
充分暴露是安全、正确地进行膝关节周围开放手术的基础。胫骨结节截骨术（TTO）此前已被描述为一种改善暴露的方法，尤其是在复杂的初次择期膝关节置换术或翻修手术中。我们描述了一种用于改善复杂膝关节骨折暴露的胫骨结节截骨术技术，并进行了一项尸体研究和创伤病例系列研究。
使用8个膝关节标本进行尸体研究，采用膝关节外侧股直肌下入路。拍摄暴露情况的标准化图片，进行胫骨结节截骨术，并拍摄新暴露区域的图片。使用计算机程序比较这些图像，该程序计算胫骨结节截骨术前和术后的暴露面积，并对结果进行分析。然后将该技术应用于6例不同的复杂膝关节骨折病例系列，包括3例股骨远端骨折、1例假体周围股骨远端骨折和2例胫骨平台骨折。对这些患者的临床和影像学结果进行随访。
尸体研究中的所有标本在胫骨结节截骨术后暴露面积均增加，平均增加148%。创伤病例系列中进行的所有胫骨结节截骨术在6个月时均愈合，无并发症。
胫骨结节截骨术是一种公认的改善膝关节暴露的技术。这已在尸体研究和一组6例膝关节周围复杂骨折的病例系列中得到证实。如果操作得当，该技术可扩展至合适的创伤病例，并取得良好效果。
