Samsami Shabnam, Pätzold Robert, Neuy Tim, Greinwald Markus, Müller Peter E, Chevalier Yan, Püschel Klaus, Augat Peter
Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom.
Department of Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany.
J Orthop Trauma. 2022 Apr 1;36(4):e129-e135. doi: 10.1097/BOT.0000000000002257.
Because management of bicondylar tibial plateau fractures are complicated even for expert surgeons, with using a coronal fracture model, we aimed to compare 2 kinds of double locked plating techniques that consisted of the lateral locking plate and the medial locking plate inserted medial anteriorly (MA-ly) or medial posteriorly (MP-ly).
Fourteen fresh-frozen tibias stabilized with the MA or MP methods were allocated into 2 groups with similar bone mineral density values. Implanted samples were tested under incremental fatigue loading conditions using a customized load applicator. An optical motion tracking system was used to assess relative displacements and rotations of fracture fragments during loading. Static and dynamic global stiffness, failure load, failure cycles, as well as movements of fracture fragments were measured.
There were no significant differences between the 2 fixation methods regarding global stiffness, failure load, or failure cycles (P = 0.67-0.98, depending on the parameter). The kinematic evaluations, however, revealed that different positions of the medial locking plates altered the directions of movements for the medial-anterior or medial-posterior fracture segments.
The mechanical stability of tibia-implant constructs fixed with the double plating methods was not remarkably affected by the location of the medial locking plate. Depending on clinical conditions and surgeons' preferences, bicondylar tibial plateau fractures can be managed with either MA or MP methods.
由于双髁胫骨平台骨折的治疗即使对于专业外科医生来说也很复杂，我们使用冠状骨折模型，旨在比较两种双锁定钢板技术，这两种技术由外侧锁定钢板和分别从前内侧（MA-ly）或后内侧（MP-ly）插入的内侧锁定钢板组成。
采用MA或MP方法固定的14根新鲜冷冻胫骨被分配到两组，两组的骨密度值相似。使用定制的载荷施加器在递增疲劳载荷条件下对植入样本进行测试。使用光学运动跟踪系统评估加载过程中骨折碎片的相对位移和旋转。测量静态和动态整体刚度、破坏载荷、破坏循环以及骨折碎片的移动情况。
在整体刚度、破坏载荷或破坏循环方面，两种固定方法之间没有显著差异（P = 0.67 - 0.98，取决于参数）。然而，运动学评估显示，内侧锁定钢板的不同位置改变了前内侧或后内侧骨折段的移动方向。
双钢板固定方法固定的胫骨-植入物结构的机械稳定性不受内侧锁定钢板位置的显著影响。根据临床情况和外科医生的偏好，双髁胫骨平台骨折可以采用MA或MP方法进行治疗。
