Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma Surgery, Orthopaedics and Sports Orthopaedics, Asklepios Clinic St Georg, Hamburg, Germany.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):4031-4041. doi: 10.1007/s00068-022-01927-w. Epub 2022 Mar 17.
Direct visualization is a very effective method in accomplishing adequate articular surface reconstruction in fracture repair. This study investigates distal tibial plafond articular surface visibility using the anteromedial, anterolateral, posteromedial, and posterolateral approaches, the effect of instrumented distraction on visibility, and which zones of the articular surface are visible for each approach.
The anteromedial, anterolateral, posteromedial, and posterolateral approaches to the distal tibial plafond were performed on 16 cadaveric ankle specimens. The articular surface visualization for each approach was marked using an electrocautery device with manual and instrumented distraction. Articular surface visualization was photographically documented. Digital axial segmentation and quantitative analysis of the visualized distal tibial plafond articular surface were performed.
With manual distraction, distal tibial plafond articular surface visualization, expressed in percent of overall articular surface, was limited to 9% (SD ± 9) for the anteromedial, 24% (SD ± 18) for the anterolateral, 26% (SD ± 10) for the posteromedial, and 30% (SD ± 18) for the posterolateral approaches. Using instrumented distraction significantly improved articular surface visualization in all instances (p < 0.001). The anteromedial approach visible articular surface increased to 63% (SD ± 13), the anterolateral to 72% (SD ± 22), the posteromedial to 62% (SD ± 11), and the posterolateral to 50% (± 17).
This study demonstrates the efficacy of instrumented distraction when attempting surgical visualization of the distal tibial plafond articular surface. Knowledge of approach specific articular surface visibility may assist the surgeon in choosing the appropriate approach(es) based on case-specific distal tibial plafond fracture patterns.
IV, cadaver study.
直接可视化是完成骨折修复中关节面充分重建的非常有效的方法。本研究通过前内侧、前外侧、后内侧和后外侧入路，研究了胫骨远端平台关节面的可视性，仪器牵引对可视性的影响，以及每个入路可见的关节面区域。
对 16 个尸体踝关节标本进行了胫骨远端平台的前内侧、前外侧、后内侧和后外侧入路。使用电烙器设备，通过手动和仪器牵引标记每个入路的关节面可视性。记录关节面可视化的照片。对可见的胫骨远端平台关节面进行数字轴向分割和定量分析。
在手动牵引下，胫骨远端平台关节面可视化程度（以关节面总面积的百分比表示），前内侧为 9%（SD ± 9），前外侧为 24%（SD ± 18），后内侧为 26%（SD ± 10），后外侧为 30%（SD ± 18）。使用仪器牵引可显著提高所有情况下的关节面可视化程度（p < 0.001）。前内侧入路的可见关节面增加到 63%（SD ± 13），前外侧入路增加到 72%（SD ± 22），后内侧入路增加到 62%（SD ± 11），后外侧入路增加到 50%（± 17）。
本研究表明，在试图对胫骨远端平台关节面进行手术可视化时，仪器牵引是有效的。了解特定入路的关节面可视性可以帮助外科医生根据特定的胫骨远端平台骨折模式选择合适的入路。
IV，尸体研究。
