Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai 200090, China.
Biomed Res Int. 2020 Dec 3;2020:4186712. doi: 10.1155/2020/4186712. eCollection 2020.
The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48° ± 8.88° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.
胫骨平台后外侧骨折不易用常规技术暴露和固定。本研究旨在探讨经前外侧腓骨头上方入路固定胫骨平台后外侧骨折的单一水平带钢板的生物力学稳定性和临床疗效。通过 18 个合成胫骨创建骨折模型，并采用三种不同的固定方式进行固定。每组在加载机上进行固定和测试，并检测和计算骨折块的最终垂直位移。临床方面，对 2013 年 1 月至 2017 年 12 月的 12 例胫骨平台后外侧骨折患者进行回顾性分析。其中男 8 例，女 4 例；年龄 33-72 岁，平均年龄 49.6 岁。根据术前 X 线和 CT 扫描确定为单纯胫骨平台后外侧骨折。通过改良的前外侧腓骨头上方入路，采用预弯 T 形桡骨远端钢板和浮标螺钉复位固定骨折，同时进行骨替代物移植或自体髂骨植入。患者至少随访 1 年，临床和影像学评估疗效。生物力学研究表明，水平带钢板固定单纯胫骨平台后外侧骨折可提供足够的稳定性，允许早期膝关节功能锻炼和部分负重。对于临床病例系列，该组的平均手术时间为 73.3 ± 10.2 分钟（范围：55-90 分钟），平均住院时间为 9.1 ± 3.3 天（范围：5-16 天）。患者平均随访 12-24 个月，平均 16.5 个月，所有患者平均 13.7 周后 X 线骨折愈合。术后 1 年，美国特种外科医院（HSS）膝关节评分平均为 93.2 ± 4.2 分（范围：90-98 分），简易功能评估量表（SMFA）平均评分为 21.1 ± 5.6 分（范围：14-31 分），膝关节平均活动度（ROM）为 121.48°±8.88°（范围：105°-135°）。8 例患者非常满意，3 例患者满意手术。对于单纯胫骨平台后外侧骨折，腓骨头上方入路可充分暴露骨折部位；骨折的水平带钢板固定稳定可靠，可早期进行膝关节康复，中期临床随访结果满意。
