Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
Injury. 2020 Aug;51(8):1874-1878. doi: 10.1016/j.injury.2020.05.038. Epub 2020 May 25.
Comminuted lateral tibial plateau fractures pose a challenge to surgeons, with non-anatomical reductions in 70-89%, involving the posterolateral articular surface. The purpose of this study was to examine the posterolateral joint visibility, using lateral extended approaches, such as the lateral femoral epicondyle osteotomy or the fibula osteotomy. Further, the study aimed to compare the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) to the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy, in terms of posterolateral joint accessibility.
Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knees. After preparation of each surgical approach, the visible articular surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p ≤ 0.05).
The greatest articular exposure was achieved with the fibula osteotomy (1011.52 ± 227.05 mm [86.64 ± 4.84%] compared to the combined osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm [80.29 ± 8.25%]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm [64.73 ± 6.51%], p < 0.001).
In direct comparison, the fibula osteotomy provides the largest articular visualization, however at cost of a considerably larger soft tissue damage. While the lateral femoral epicondyle osteotomy of LCL and PLT increases lateral articular visualization, it omits the risk of neurovascular or posterolateral soft tissue damage and therefore represents an important extended approach to treat comminuted lateral plateau fractures.
粉碎性胫骨平台外侧骨折对外科医生来说是一个挑战，70-89%的患者存在非解剖复位，涉及后外侧关节面。本研究的目的是通过外侧延伸入路（如股骨外上髁截骨或腓骨截骨）检查后外侧关节的可视性。此外，还旨在比较外侧副韧带（LCL）和腘肌腱（PLT）的联合股骨足迹切开术与单独的 LCL 股骨足迹切开术或腓骨切开术在后外侧关节可及性方面的差异。
对 12 个人体尸体膝关节进行了外侧延伸（股骨或腓骨 LCL 截骨）和后外侧（额外的 PLT 肌腱的股骨切开术）入路。在准备好每种手术入路后，用透热疗法标记关节表面。游离胫骨平台，并使用开源处理软件对标记进行数字测量。采用配对 t 检验（p≤0.05）检验均值差异。
腓骨截骨术可获得最大的关节暴露（1011.52±227.05mm[86.64±4.84%]），明显优于 LCL 和 PLT 联合截骨术（p=0.036）或单独 LCL 截骨术（p<0.001）。包括 PLT 的 LCL 外侧股骨外上髁截骨术（937.45±237.84mm[80.29±8.25%]）暴露的外侧胫骨平台关节面明显大于不包括 PLT 的截骨术（755.71±183.06mm[64.73±6.51%]，p<0.001）。
直接比较，腓骨截骨术提供了最大的关节可视化，但代价是相当大的软组织损伤。虽然 LCL 和 PLT 的外侧股骨外上髁截骨术增加了外侧关节的可视化，但避免了神经血管或后外侧软组织损伤的风险，因此代表了治疗粉碎性外侧平台骨折的一种重要的扩展入路。
