Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
Orthop Traumatol Surg Res. 2024 Apr;110(2):103655. doi: 10.1016/j.otsr.2023.103655. Epub 2023 Jul 7.
Associating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach.
A retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires.
Major complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months' follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up.
The present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months' follow-up.
III; case-control study.
与后内侧和前外侧入路联合应用，应能改善骨折线的可视化程度，并优化双髁胫骨平台骨折的复位，优于单一的正中入路。本研究旨在比较单一切口与双切口双钢板固定术后并发症发生率及功能和影像学结果。研究假设是，与单一切口相比，双切口双钢板固定术能提供等效的并发症发生率，并改善影像学结果。
本回顾性的 2 中心研究比较了 2016 年 1 月至 2020 年 12 月期间，采用单一切口与双切口双钢板固定治疗双髁胫骨平台骨折。比较重点为需要手术修正的主要并发症、内侧近端胫骨角（MPTA）和后近端胫骨角（PPTA）的影像学测量值；与各自 87°和 83°的基线值相比的变化（deltaMPTA 和 deltaPPTA），以及 KOOS、SF12 和 EQ5D-3L 自我报告问卷的功能结果。
20 例单一切口组患者中有 2 例（10%）[1 例手术部位感染（SSI）（5%），1 例皮肤并发症（5%）]发生主要并发症，39 例双切口组患者中有 3 例（7.69%）（p=0.763），平均随访 29 个月。在矢状面，双切口组的 deltaPPTA 明显低于单一切口组（分别为 4.67°与 7.43°；p=0.0104）。末次随访时，两组间 deltaMPTA 或功能结果无显著差异。
本研究表明，在双髁胫骨平台骨折的双钢板骨合成中，单一切口与双切口之间在主要并发症方面无显著差异。采用双切口可改善矢状面的解剖复位，而在平均 29 个月的随访中，在额状面或功能评分方面无显著差异。
III；病例对照研究。
