Herbst Elmar, Wessolowski Moritz A, Raschke Michael J
Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, 48149 Muenster, Germany.
J Clin Med. 2023 Aug 10;12(16):5208. doi: 10.3390/jcm12165208.
The treatment of medial tibial plateau fractures can be challenging due to poor exposure of the articular surface. Therefore, a medial epicondyle osteotomy may be needed. Current methods describe osteotomy of the medial femoral epicondyle. However, this method requires additional detachment of the medial meniscus in order to ensure proper visualization. The aim of this study is to present a new technique using distal osteotomy of the superficial medial collateral ligament and to analyze the area of the exposed articular surface area. On each of eight fresh-frozen human cadaveric knees (mean age: 79.4 ± 9.4 years), an osteotomy and proximal reflection of the distal insertion of the superficial medial collateral ligament combined with a submeniscal arthrotomy was performed, followed by a medial epicondyle osteotomy. Using a three-dimensional measurement arm (Absolute Arm 8320-7, Hexagon Metrology GmbH), the exposed area was analyzed and compared to the entire medial articular surface using ANOVA ( < 0.05). Through the medial epicondyle osteotomy, 39.9 ± 9.7% of the anteromedial articular surface was seen. This area was significantly smaller compared to the osteotomy of the distal insertion of the superficial collateral ligament with an exposed articular surface of 77.2 ± 16.9% ( = 0.004). Thus, the distal osteotomy exposed 37.3% more of the articular surface compared to the medial epicondyle osteotomy. None of these techniques were able to adequately expose the posteromedial- and medial-most aspects of the tibial plateau. A distal superficial collateral ligament osteotomy may be superior to a medial epicondyle osteotomy when an extension of the anteromedial approach to the tibial plateau is required. A distal superficial medial collateral ligament osteotomy combines the advantages of better exposure of the medial articular surface with preservation of the blood supply to the medial meniscus. However, surgeons should carefully consider whether such an extended approach is necessary, as it significantly increases invasiveness.
由于胫骨内侧平台骨折的关节面暴露不佳，其治疗颇具挑战性。因此，可能需要进行内侧髁上截骨术。目前的方法描述的是股骨内侧髁截骨术。然而，这种方法需要额外分离内侧半月板以确保良好的视野。本研究的目的是介绍一种使用浅层内侧副韧带远端截骨术的新技术，并分析暴露的关节面面积。在8个新鲜冷冻的人体尸体膝关节（平均年龄：79.4±9.4岁）上，均进行了浅层内侧副韧带远端插入部的截骨术及近端翻转，并联合半月板下关节切开术，随后进行内侧髁上截骨术。使用三维测量臂（Absolute Arm 8320 - 7，Hexagon Metrology GmbH）分析暴露面积，并使用方差分析（<0.05）与整个内侧关节面进行比较。通过内侧髁上截骨术，可见39.9±9.7%的前内侧关节面。与浅层副韧带远端插入部截骨术相比，该面积明显较小，后者暴露的关节面为77.2±16.9%（P = 0.004）。因此，与内侧髁上截骨术相比，远端截骨术暴露的关节面多37.3%。这些技术均无法充分暴露胫骨平台的后内侧和最内侧部分。当需要将前内侧入路扩展至胫骨平台时，浅层内侧副韧带远端截骨术可能优于内侧髁上截骨术。浅层内侧副韧带远端截骨术结合了更好地暴露内侧关节面和保留内侧半月板血供的优点。然而，外科医生应仔细考虑是否需要这种扩展入路，因为这会显著增加手术创伤。
