Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.
Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
J Orthop Surg Res. 2020 Sep 3;15(1):376. doi: 10.1186/s13018-020-01901-5.
Posterolateral tibial plateau fractures (PTPF) remain a challenge for orthopedics surgeons because the special anatomical structures of the posterolateral corner of knee joint including the fibular head, the lateral collateral ligament, and the peroneal nerve, which impedes the exposure of the fracture fragments and need irregular implants to get a stable fixation. The purpose of present study was to introduce a new articular fracture fragments restoration technique for three patterns of PTPF and investigate the relationship between associated soft injuries and fracture patterns.
From May 2016 to April 2018, 31 patients with PTPF who had undertaken arthroscopically assisted reduction and fixation (AARF) were enrolled in present study. Demographic data, pre-operation, and post-operation X plan films, three-dimensional computed tomography (CT) scans and magnetic resonance imaging (MRI) were reviewed. Present samples were divided into three patterns with lateral inclination (LI), posterior inclination (PI), and parallel compression (PC) according to the orientation of the articular fragment inclination. Rasmussen anatomical score was used to assess the radiological results. Rasmussen functional score, Hospital for Special Surgery knee-rating Score (HSS), and range of motion (ROM) of the knee joint at the final follow-up were measured to evaluate the clinical outcomes.
In this series, the post-operation tibial plateau angle (TPA) was 9.7° ± 3.5°(range 4.0°-15.8°) and the Rasmussen anatomical score was 17.7 ± 0.7(range 16-18); clinical outcomes showed that the HSS score was 92.7 ± 21.8 (range 90-96) and the Rasmussen functional score was 27.9 ± 1.0 (range 26-30). Of all the patients, the anterior cruciate ligament (ACL) injuries including the ACL tibial attachment ruptures occurred in 16 patients (51.6%), meniscus lesions happened in 19 patients (61.3%), medial collateral ligament (MCL) injuries were founded in 13 patients (41.9%). The number of ACL injuries including the ACL tibial attachment ruptures in the PI fracture pattern (12 cases) is significantly higher than LI (2 cases) and PC (2 cases) fracture pattern (p < 0.05).
Profound understanding the different patterns of PTPF and using our reduction technique will facilitate to restore the main articular fracture fragments. The PI fracture patterns have a significant high incidence of the ACL ruptures.
Therapeutic study, Level IV.
胫骨平台后外侧骨折（PTPF）仍然是骨科医生面临的挑战，因为膝关节后外侧角的特殊解剖结构包括腓骨头、外侧副韧带和腓总神经，这阻碍了骨折碎片的暴露，并需要使用不规则的植入物来获得稳定的固定。本研究的目的是介绍一种新的关节骨折碎片复位技术，用于治疗三种类型的 PTPF，并研究相关软组织损伤与骨折类型的关系。
自 2016 年 5 月至 2018 年 4 月，对 31 例接受关节镜辅助复位内固定（AARF）治疗的 PTPF 患者进行了回顾性研究。分析了患者的一般资料、术前、术后 X 线片、三维 CT 扫描和磁共振成像（MRI）。根据关节面骨折块倾斜方向，将样本分为外侧倾斜（LI）、后倾斜（PI）和平行压缩（PC）三种类型。采用 Rasmussen 解剖评分评估影像学结果。采用 Rasmussen 功能评分、特殊外科医院膝关节评分（HSS）和膝关节最后随访时的活动范围（ROM）评估临床结果。
在本系列中，术后胫骨平台角（TPA）为 9.7°±3.5°（范围 4.0°-15.8°），Rasmussen 解剖评分 17.7±0.7（范围 16-18）；临床结果显示，HSS 评分为 92.7±21.8（范围 90-96），Rasmussen 功能评分为 27.9±1.0（范围 26-30）。所有患者中，前交叉韧带（ACL）损伤包括 ACL 胫骨附着处撕裂 16 例（51.6%），半月板损伤 19 例（61.3%），内侧副韧带（MCL）损伤 13 例（41.9%）。PI 骨折模式中 ACL 损伤包括 ACL 胫骨附着处撕裂的病例数（12 例）明显高于 LI（2 例）和 PC（2 例）骨折模式（p<0.05）。
深入了解 PTPF 的不同类型，并采用我们的复位技术，有助于恢复主要关节骨折碎片。PI 骨折模式 ACL 撕裂的发生率显著较高。
治疗研究，IV 级。
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