Li Dian-Qing, Song De-Ye, Ni Jiang-Dong, Ding Mu-Liang, Huang Jun
Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
Medicine (Baltimore). 2017 Nov;96(45):e8394. doi: 10.1097/MD.0000000000008394.
The knee joint is an important weight-bearing joint, tibial plateau fractures affect knee function and stability. High-energy intra-articular fractures involving the tibial plateau can cause management-related problems such as wound dehiscence; severe comminution leading to malalignment; and delayed complications such as varus collapse, implant failure, and arthritis of the knee joint. The treatment of severe or complex tibial plateau fractures can be quite difficult. Traditional methods of open reduction and plating require extensive exposures, which may further compromise soft tissue and devascularize bone fragments, leading to infection. In this case, a novel device, double reverse traction combined with MIPPO technique, was used and provided the possibility of minimally invasive and personalized orthopedic surgery to treat severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture and got satisfactory results.
A previously healthy 56-year-old man presented to the emergency room after a fall from a height, who lost the movement of the left knee with pain and swelling.
X-rays showed a tibial plateau comminuted fracture, Schatzker type VI, and tibial shaft fracture.
Applying less extensile exposure and the indirect reduction technique of double reverse traction and closed reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique, we got satisfactory recovery of the severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture.
This severe comminuted fracture and tibial shaft fracture were successfully reduced and got satisfactory recovery of knee joint function.
Double reverse traction combined with MIPPO technique can reduce the risk of surgical complications, such as bleeding, oozing, and wound infection. It can be applied in patients with comorbidities such as cardiac disease, hypertension, and heart failure who may otherwise not be candidates for surgery. The cost burden is lower than that of the traditional traction table.
膝关节是重要的负重关节，胫骨平台骨折会影响膝关节功能和稳定性。涉及胫骨平台的高能关节内骨折会引发与治疗相关的问题，如伤口裂开；严重粉碎导致畸形排列；以及诸如内翻塌陷、植入物失败和膝关节关节炎等延迟并发症。严重或复杂的胫骨平台骨折治疗起来可能相当困难。传统的切开复位钢板固定方法需要广泛暴露，这可能会进一步损害软组织并使骨碎片缺血，导致感染。在本病例中，使用了一种新型装置，即双反向牵引结合微创经皮钢板接骨术（MIPPO）技术，为治疗严重粉碎性Schatzker VI型胫骨平台骨折和胫骨干骨折提供了微创和个性化骨科手术的可能性，并取得了满意的效果。
一名56岁既往健康男性因高处坠落后来到急诊室，左膝关节疼痛、肿胀且活动受限。
X线显示为Schatzker VI型胫骨平台粉碎性骨折及胫骨干骨折。
采用较少的扩展性暴露以及双反向牵引间接复位技术和闭合复位结合微创经皮钢板接骨术（MIPPO）技术，严重粉碎性Schatzker VI型胫骨平台骨折和胫骨干骨折获得了满意的恢复。
该严重粉碎性骨折和胫骨干骨折成功复位，膝关节功能恢复满意。
双反向牵引结合MIPPO技术可降低手术并发症的风险，如出血、渗血和伤口感染。它可应用于患有心脏病、高血压和心力衰竭等合并症而原本可能不适合手术的患者。成本负担低于传统牵引床。
