Karas E H, Weiner L S, Yang E C
Department of Orthopaedic Surgery, Mount Sinai School of Medicine, New York, New York, USA.
J Orthop Trauma. 1996;10(4):243-7. doi: 10.1097/00005131-199605000-00004.
The purpose of this study was to examine the use of an anterior incision of the meniscus for exposure of tibial plateau fractures. We studied 27 fractures of the proximal tibia treated with open reduction and internal fixation (ORIF). There were nine unicondylar fractures (five A-O B2; four A-O B3) fixed with plates and screws and 18 bicondylar fractures (seven A-O C1; five A-O C2; six A-O C3) fixed with combination internal and external fixation. Length of follow-up averaged 26 months. All patients were treated with an anterior incision of the meniscus and retraction with the condyle. Of the 18 bicondylar fractures, nine severely displaced fractures were found to have peripherally detached menisci. Unicondylar fractures did not display this finding. After fixation, menisci were repaired at the periphery and sewn to the original anterior insertion. The repair begins posteriorly and advances the cartilage to ensure anatomic placement. There were four medial and 23 lateral menisci in this series. Ten patients underwent knee arthroscopy 6 months to 2 years post-ORIF as a routine procedure during hardware removal. All menisci were found to be healed to the periphery and were stable. There were no gross tears. In one patient, the anterior meniscal incision could be visualized. No patients developed mechanical symptoms either in postoperative rehabilitation or postoperative follow-up at a maximum of 6 years. All patients had > 125 degrees of motion. Less motion when compared with the normal knee was felt to be related to more complex fracture patterns. In conclusion, the anterior meniscal incision allows for excellent exposure of severe proximal tibia fractures. This technique allows for anatomic meniscal repair and early rehabilitation. Arthroscopic examination confirms peripheral meniscal healing. No patient experienced clinical symptoms of meniscal pathology.
本研究的目的是探讨采用半月板前切口暴露胫骨平台骨折的情况。我们研究了27例接受切开复位内固定（ORIF）治疗的胫骨近端骨折。其中9例单髁骨折（5例A-O B2型；4例A-O B3型）采用钢板螺钉固定，18例双髁骨折（7例A-O C1型；5例A-O C2型；6例A-O C3型）采用内固定与外固定联合固定。平均随访时间为26个月。所有患者均采用半月板前切口并将髁部牵开进行治疗。在18例双髁骨折中，发现9例严重移位骨折伴有半月板周边分离。单髁骨折未出现此情况。固定后，半月板在周边进行修复并缝合至原来的前插入处。修复从后方开始并推进软骨以确保解剖位置。本系列中有4个内侧半月板和23个外侧半月板。10例患者在ORIF术后6个月至2年进行膝关节镜检查，作为取出内固定装置时的常规操作。发现所有半月板均已愈合至周边且稳定。无明显撕裂。在1例患者中，可以看到半月板前切口。在术后康复或最长6年的术后随访中，没有患者出现机械性症状。所有患者膝关节活动度均大于125度。与正常膝关节相比活动度较小被认为与骨折类型更复杂有关。总之，半月板前切口能很好地暴露严重的胫骨近端骨折。该技术可实现半月板解剖修复和早期康复。关节镜检查证实半月板周边愈合。没有患者出现半月板病变的临床症状。
