Cardon Jeffrey J, DeKeyser Graham J, Peterson Andrew C, Higgins Thomas F, Lenz Amy L, Haller Justin M
Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT.
J Orthop Trauma. 2023 Jan 1;37(1):44-49. doi: 10.1097/BOT.0000000000002462.
Compare accessible area of the posterior tibial plateau through a modified posteromedial (PM) approach before and after tenotomy of the medial head gastrocnemius. We report the outcomes of 8 patients who underwent gastrocnemius tenotomy during PM approach.
A modified PM approach was performed on 10 cadaveric legs, and the surgically accessible area was outlined. Next, a medial head gastrocnemius mid substance tenotomy was completed, and the accessible area was again outlined. Tibia specimens were imaged in a micro-CT scanner to measure accessible surface area and linear distance along the joint line. In addition, 8 patients who underwent tenotomy for tibial plateau fracture had outcomes recorded.
The modified PM approach with tenotomy provided significantly more access to the posterior plateau than without tenotomy. The modified PM approach before tenotomy allowed access to 1774 mm 2 (SD = 274) of the posterior plateau surface and 2350 mm 2 (SD = 421, P < 0.0001) with tenotomy. A linear distance of 38 mm (SD = 7) and 57 mm (SD = 7, P < 0.00001) was achieved before and after tenotomy, respectively. In the clinical series, the average knee arc of motion was 116 degrees (95-135).
The modified PM approach with medial head gastrocnemius tenotomy significantly improves surgical access to the posterior plateau. Patients who received tenotomy have acceptable functional outcomes. This cadaveric study provides an alternative approach for treatment of posterolateral tibial plateau fractures which may mitigate damage to neurovascular structures.
比较内侧头腓肠肌肌腱切断术前、后经改良后内侧（PM）入路时胫骨后平台的可及面积。我们报告了8例在PM入路期间接受腓肠肌肌腱切断术患者的治疗结果。
对10条尸体下肢采用改良PM入路，并勾勒出手术可及区域。接下来，完成内侧头腓肠肌中间部分肌腱切断术，再次勾勒出可及区域。将胫骨标本在微型CT扫描仪中成像，以测量可及表面积和沿关节线的线性距离。此外，记录了8例因胫骨平台骨折接受肌腱切断术患者的治疗结果。
与未行肌腱切断术相比，行肌腱切断术的改良PM入路能显著增加对后平台的显露。肌腱切断术前改良PM入路可显露后平台表面1774平方毫米（标准差=274），肌腱切断术后为2350平方毫米（标准差=421，P<0.0001）。肌腱切断术前、后沿关节线的线性距离分别为38毫米（标准差=7）和57毫米（标准差=7，P<0.00001）。在临床系列研究中，膝关节平均活动弧度为116度（95-135）。
采用内侧头腓肠肌肌腱切断术的改良PM入路可显著改善对后平台的手术显露。接受肌腱切断术的患者功能预后良好。这项尸体研究为治疗胫骨后外侧平台骨折提供了一种替代方法，可能会减轻对神经血管结构的损伤。
