Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Injury. 2020 Mar;51(3):723-734. doi: 10.1016/j.injury.2020.01.023. Epub 2020 Jan 22.
The articular congruity of tibial plateau has been stressed to be associated with the long-term function outcomes. Approach selection and fixation pattern to manipulate the posterolateral (PL)-depression of tibial plateau are both key issues which trauma surgeons should focus on. In order to provide a strong purchase of PL-depression, we developed a new modified Frosch approach and a "Barrel hoop plate" technique to provide bony reconstruction of PL-depression.
Eleven consecutive patients of tibial plateau fractures involved in PL-depression were surgically treated at our single level-I trauma center. Our newly designed "Barrel hoop plate" was used to fix the PL-depression via a modified Frosch approach. The demography and treatment information were summarized of all the patients. X-ray and CT-scan of the knee joint were used to assess the reduction after operation. Besides evaluation of the HSS knee score, medial tibial plateau angle(mTPA), posterior slope angle(PSA) and articular step-off were measured to assess the malreduction degrees.
The average operation time was 123 ± 20 min. The mean blood loss was 148 ± 45 mL. The fractures were healed radiographically at 13 ± 1 weeks post-operation. After 15 ± 2 months follow-up, all the patients were pain-free with full range of motion and stable knees. Radiologically, good fracture reduction was achieved in all cases. According to the final assessment, the mTPA, m-PSA and l-PSA were 85° ± 2°, 11° ± 5° and 10° ± 6°, respectively. The average range of motion was 128° ± 10°in flexion and 4° ± 4° in extension, and the average HSS score was 91 ± 3.
Our new approach is a modification of the Frosch approach with a decreased soft tissue exposure and a low risk of neurovascular vessel injury. The concurrent application of the "Barrel hoop plate" technique could not only provide a reconstruction of the PL tibial plateau, but also hoop the ruptured tibia plateau rim and secure the depression as a raft. This new technique prevented the PL-tibial plateau reduction loss and the made the patients' early range of motion come true.
关节吻合度一直被认为与胫骨平台骨折的长期功能结果有关。选择入路和固定方式来处理胫骨平台后外侧（PL）凹陷是创伤外科医生应关注的关键问题。为了提供 PL 凹陷的牢固固定，我们开发了一种新的改良 Froch 入路和“桶箍板”技术来提供 PL 凹陷的骨重建。
在我们的单一一级创伤中心，连续 11 例胫骨平台骨折伴 PL 凹陷的患者接受了手术治疗。我们新设计的“桶箍板”通过改良 Froch 入路固定 PL 凹陷。总结了所有患者的人口统计学和治疗信息。膝关节 X 线和 CT 扫描用于评估术后复位情况。除了 HSS 膝关节评分评估外，还测量内侧胫骨平台角（mTPA）、后倾角（PSA）和关节台阶来评估复位不良程度。
平均手术时间为 123±20 分钟。平均失血量为 148±45ml。术后 13±1 周 X 线片显示骨折愈合。15±2 个月随访时，所有患者膝关节无痛，活动度完全正常，膝关节稳定。影像学上，所有病例均获得良好的骨折复位。根据最终评估，mTPA、m-PSA 和 l-PSA 分别为 85°±2°、11°±5°和 10°±6°。膝关节屈曲平均活动度为 128°±10°，伸展平均活动度为 4°±4°，HSS 评分平均为 91±3。
我们的新方法是 Froch 入路的改良，减少了软组织暴露，降低了神经血管损伤的风险。“桶箍板”技术的同时应用不仅可以提供 PL 胫骨平台的重建，还可以箍紧破裂的胫骨平台边缘，并将凹陷作为一个筏固定。这种新技术防止了 PL 胫骨平台复位丢失，并使患者早期实现活动范围。
