Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3163-3172. doi: 10.1007/s00402-022-04554-7. Epub 2022 Jul 30.
To date, there is no consensus on the optimal surgical strategy for the treatment of posterolateral tibial plateau fracture (PLF). This study introduced a novel, simple technique for treating PLF with a lateral locking plate plus antero-posterior lag screws (LPpLS).
We conducted a retrospective case series of 42 patients (Female/Male 19/23) with PLF treated with LPpLS between 1 July 2016 and 30 June 2019. Several pre- and postoperative outcomes were recorded, including operative time, intraoperative blood loss, CT findings, HSS, and ROM. For biomechanical studies, seventy synthetic tibiae with a simulated posterolateral split fracture were divided into seven groups. The biomechanical evaluation included displacement measurement at axial compression and fatigue testing.
Forty-two eligible patients were followed up for an average of 18 months (range 14-21 months). Postoperative radiographs and CT showed good positioning of plates and screws, no fracture fragment loss, and normal articular surfaces in all 42 cases. The biomechanical study showed that the axial stiffness of LPpLS was in the same fashion as the posterior buttress plate and better than the other fixation methods (P < 0.05). Additionally, the LPpLS group had a smaller displacement of fracture fragments along the X-axis (medial to lateral direction) than the BP group (P < 0.01).
The LPpLS technique could implement good reconstruction of the PLF, showing satisfactory therapeutic effect. The biomechanical evaluation demonstrated that the LPpLS had better stability in three-dimensional directions for PLF than other fixation strategies.
迄今为止，对于胫骨平台后外侧骨折（PLF）的治疗，尚无最佳的手术策略。本研究介绍了一种使用外侧锁定钢板加前后拉螺钉（LPpLS）治疗 PLF 的新颖、简单技术。
我们回顾性分析了 2016 年 7 月 1 日至 2019 年 6 月 30 日期间使用 LPpLS 治疗的 42 例（女/男 19/23）PLF 患者的病例系列。记录了包括手术时间、术中失血量、CT 表现、HSS 和 ROM 在内的多项术前和术后结果。对于生物力学研究，70 个模拟后外侧劈裂骨折的合成胫骨分为 7 组。生物力学评估包括轴向压缩和疲劳试验时的位移测量。
42 例符合条件的患者平均随访 18 个月（范围 14-21 个月）。所有 42 例患者术后 X 线片和 CT 均显示钢板和螺钉位置良好，无骨折块丢失，关节面正常。生物力学研究表明，LPpLS 的轴向刚度与后支撑钢板相似，优于其他固定方法（P<0.05）。此外，LPpLS 组骨折碎片沿 X 轴（内侧到外侧方向）的位移小于 BP 组（P<0.01）。
LPpLS 技术可实现 PLF 的良好重建，疗效满意。生物力学评估表明，LPpLS 在三维方向上对 PLF 的稳定性优于其他固定策略。
