Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
Orthopedic Research Institution, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
BMC Musculoskelet Disord. 2022 May 5;23(1):420. doi: 10.1186/s12891-022-05387-6.
Anteromedial tibial plateau fracture with posterolateral corner (PLC) injury is a relatively rare combined injury in the clinic. In addition, there is no unified treatment scheme for this combined injury. The purpose of this study was to evaluate the clinical and imaging results of single-stage arthroscopic-assisted surgery for anteromedial tibial plateau fracture with PLC injury, and to explore the advantages of this surgical technique.
In this retrospective study, a total of 9 patients (7 males and 2 females) were included, aged 24-64 years (average 40.7 years), treated in our Department of Orthopedics from January 2016 to January 2021. In the preoperative evaluations, there were 9 cases of anteromedial tibial plateau fractures with PLC injuries, 6 cases of concomitant PCL injuries, 6 cases of concomitant medial or lateral meniscus injuries, and 2 cases of concomitant fibular head avulsion fractures. All patients underwent single-stage arthroscopic-assisted surgery.
All patients were followed up, and the average follow-up period was 15.2 months (range 12-18 months). The average operation time was 135.6 min (range 100-160 min), and the average surgical blood loss was 87.2 ml (range 60-110 ml). The anatomical reduction was achieved in 9 cases, and the anatomical reduction rate was 100%. The average fracture healing time was 13.1 weeks (range 12-16 weeks). At the last follow-up, the average VAS score was 1 (range 0-2); the average Lysholm function score was 90.7 (range 86-95), and the average IKDC score was 91.4 (range 88-95); the average knee extension angle of all patients was 0° and the average knee flexion angle was 128.3° (average 120-135°); The posterior drawer test, the Lachman test and the dial test were negative for all cases. None of the patients had operation-related complications.
Single-stage arthroscopy-assisted surgery in the treatment of anteromedial tibial plateau fracture with PLC injury can achieve good clinical outcomes, restore the stability of the knee joint, and reduce the risk of severe lower extremity dysfunction.
前内侧胫骨平台骨折合并后外侧角（PLC）损伤在临床上较为少见。此外，对于这种联合损伤还没有统一的治疗方案。本研究旨在评估一期关节镜辅助手术治疗前内侧胫骨平台骨折合并 PLC 损伤的临床和影像学结果，并探讨该手术技术的优势。
在这项回顾性研究中，共纳入 9 例（7 名男性和 2 名女性）患者，年龄 24-64 岁（平均 40.7 岁），均于 2016 年 1 月至 2021 年 1 月在我院骨科接受治疗。在术前评估中，9 例为前内侧胫骨平台骨折合并 PLC 损伤，6 例合并后交叉韧带（PCL）损伤，6 例合并内侧或外侧半月板损伤，2 例合并腓骨头撕脱骨折。所有患者均接受一期关节镜辅助手术治疗。
所有患者均获得随访，平均随访时间为 15.2 个月（范围 12-18 个月）。平均手术时间为 135.6 分钟（范围 100-160 分钟），平均手术失血量为 87.2ml（范围 60-110ml）。9 例获得解剖复位，解剖复位率为 100%。平均骨折愈合时间为 13.1 周（范围 12-16 周）。末次随访时，VAS 评分为 1 分（范围 0-2 分）；Lysholm 功能评分为 90.7 分（范围 86-95 分），IKDC 评分为 91.4 分（范围 88-95 分）；所有患者的膝关节伸直角度均为 0°，膝关节屈曲角度为 128.3°（平均 120-135°）；所有患者的后抽屉试验、lachman 试验和轴移试验均为阴性。所有患者均未发生与手术相关的并发症。
一期关节镜辅助手术治疗前内侧胫骨平台骨折合并 PLC 损伤可获得良好的临床疗效，恢复膝关节稳定性，降低严重下肢功能障碍的风险。
