Ren Weizhi, Zhang Wen, Jiang Shijie, Peng Jian, She Chang, Li Liubing, Mao Yongtao, Zhou Haibin, Xu Wei
Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Orthopedic Institute, Soochow University, Suzhou, China.
Front Bioeng Biotechnol. 2022 Mar 8;10:818610. doi: 10.3389/fbioe.2022.818610. eCollection 2022.
There is no consensus about the optimal internal fixation selection for treatment of posterolateral tibial plateau fracture. This study described a novel plate through an anterolateral approach for posterolateral tibial plateau fractures (PTPFs). We evaluated the biomechanical performance of a novel plate and two conventional internal implants and investigated the anatomic feasibility of the novel plate. The fracture models were randomly assigned into six groups: Groups A-C were the model groups of posterolateral split fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. Groups D-E were the model groups of posterolateral depression fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. We evaluated the biomechanical performance of six model groups by the biomechanical testing and finite element analysis. Progressively increasing axial compressive loads were applied to each synthetic fracture model by using a customized indentor under 250-750 N loads. Meanwhile, we dissected 12 fresh frozen knee specimens and fixed them with the novel plate through the anterolateral approach. We recorded the adjacency of the novel plate to important anatomic structures. Biomechanical testing showed that the novel plate had the least displacement, followed by the posterior buttress plate, and the lateral plate had the most displacement in posterolateral split fracture. There was no significant difference in the displacement between the novel plate and the lateral plate at different loads in posterolateral depression fractures. And the posterior buttress plate showed the most displacement. In the finite element analysis, the maximum stress values of Groups A, B, and C were 383.76, 414.63, and 305.07 MPa under the load of 750 N, respectively. The maximum stress values of Groups D, E, and F were 474.28, 436.31, and 413.4 MPa under the load of 750 N, respectively. In the anatomic study, the placement of the novel plate had a low risk of damage to the important anatomic structures of knee posterolateral corner. The novel plate could be a great choice for the treatment of PTPFs due to better biomechanical performance and easy manipulation.
对于治疗胫骨平台后外侧骨折的最佳内固定选择尚无共识。本研究描述了一种通过前外侧入路治疗胫骨平台后外侧骨折（PTPF）的新型钢板。我们评估了一种新型钢板和两种传统内固定植入物的生物力学性能，并研究了新型钢板的解剖学可行性。骨折模型被随机分为六组：A - C组为后外侧劈裂骨折模型组，分别用后支撑钢板、外侧锁定钢板和新型钢板固定。D - E组为后外侧凹陷骨折模型组，分别用后支撑钢板、外侧锁定钢板和新型钢板固定。我们通过生物力学测试和有限元分析评估了六个模型组的生物力学性能。使用定制压头在250 - 750 N载荷下对每个合成骨折模型施加逐渐增加的轴向压缩载荷。同时，我们解剖了12个新鲜冷冻膝关节标本，并通过前外侧入路用新型钢板进行固定。我们记录了新型钢板与重要解剖结构的毗邻关系。生物力学测试表明，在后外侧劈裂骨折中，新型钢板的位移最小，其次是后支撑钢板，外侧钢板的位移最大。在后外侧凹陷骨折中，不同载荷下新型钢板和外侧钢板之间的位移无显著差异。而后支撑钢板的位移最大。在有限元分析中，A、B和C组在750 N载荷下的最大应力值分别为383.76、414.63和305.07 MPa。D、E和F组在750 N载荷下的最大应力值分别为474.28、436.31和413.4 MPa。在解剖学研究中，新型钢板的放置对膝关节后外侧角重要解剖结构造成损伤的风险较低。由于具有更好的生物力学性能和易于操作，新型钢板可能是治疗PTPF的一个很好的选择。
