Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China 050051.
Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, China 050051.
Biomed Res Int. 2021 Aug 24;2021:1249734. doi: 10.1155/2021/1249734. eCollection 2021.
Clinically, autologous iliac crest bone grafts (ICBG) and bone tamping methods are often applied to manage depressed tibial plateau fractures (DTPFs). The purpose of this study was to describe and evaluate the technique of using structural bicortical autologous ICBG combined with the tunnel bone tamping method (TBTM) for treating DTPFs.
All patients with DTPFs who underwent structural bicortical autologous ICBG combined with TBTM from January 2016 to February 2018 were prospectively analysed. Demographics, injury, surgery, postoperative complications, and clinical outcomes were recorded. All patients were followed up for more than 30 months. Postoperative radiography and CT were employed to assess fracture healing and the reduction quality.
Forty-three of the included patients completed the follow-up. No malreduction was observed. Based on the immediate postoperative imaging, the intra-articular step-off was significantly reduced (8.19 mm preoperatively vs. 1.30 mm immediate postoperatively, < 0.001). From the immediate operation to the latest follow-up, the reduction was maintained significantly well, with a nonnegligible absolute difference (0.18 mm, = 0.108). A remarkable secondary loss of reduction (intra-articular step off > 3 mm) was found in two elderly patients (2/43, 4.65%). The incidence of complications related to the bone-graft donor and bone-graft site was 2.33% and 4.65%, respectively. At the final follow-up, the mean Hospital for Special Surgery (HSS) score of the knee was 98.19 ± 2.89, and the mean 36-Item Short-Form Health Survey (SF-36) score was 95.65 ± 4.59.
Structural bicortical autologous ICBG combined with TBTM is radiologically effective and stable in terms of complications for the DTPFs.
临床上，常应用自体髂嵴骨（ICBG）和骨打压方法来处理胫骨平台塌陷骨折（DTPF）。本研究旨在描述和评估结构性皮质自体 ICBG 联合隧道骨打压（TBTM）技术治疗 DTPF 的效果。
前瞻性分析 2016 年 1 月至 2018 年 2 月采用结构性皮质自体 ICBG 联合 TBTM 治疗的 DTPF 患者。记录患者的一般资料、损伤情况、手术情况、术后并发症及临床疗效。所有患者的随访时间均超过 30 个月。术后 X 线和 CT 评估骨折愈合和复位质量。
43 例患者完成了随访。无复位不良。术后即刻影像学检查显示关节面台阶明显减小（术前 8.19mm，术后即刻 1.30mm，<0.001）。从即刻手术到末次随访，复位保持良好，差异有统计学意义（0.18mm，=0.108）。2 例老年患者（2/43，4.65%）出现显著的复位丢失（关节面台阶>3mm）。与供骨区和植骨区相关的并发症发生率分别为 2.33%和 4.65%。末次随访时，膝关节 HSS 评分平均为 98.19±2.89，36 项简明健康状况调查问卷（SF-36）评分平均为 95.65±4.59。
结构性皮质自体 ICBG 联合 TBTM 治疗 DTPF 具有影像学效果好、并发症少的特点。
