Complex tibial plateau fractures involving posteromedial column: implantation of “bamboo raft” plate and posteromedial support plate

doi:10.3969/j.issn.2095-4344.2015.09.018

Abstract

Abstract:

BACKGROUND: Medial tibial fracture after involvement of the tibial plateau is complex fractures caused by high-energy injuries. If we cannot choose the appropriate time, reasonable fixation approach and fixation way, local skin necrosis delayed fracture healing or non-healing, internal fixation failure and knee joint dysfunction will occur.
OBJECTIVE: To investigate the method and effect of complex tibial plateau fractures of medial column after involving the tibia platform.
METHODS: On the basis of CT three-dimensional reconstruction and three-column type theory tibial plateau, data of 37 patients with complex fractures of tibial plateau involved in the medial column were retrospectively analyzed. All cases received fixation treatment. Anterior lateral incision and medial incision fixation approaches were used. The lateral side used “bamboo raft” type anatomic locking plate fixation, formulated by Association for the Study of Internal Fixation. Posteromedial column used this locking fixation plate according to fracture situation. Moreover, artificial bone graft was performed. The recovery of knee joint function was assessed using Merchant scoring criteria.
RESULTS AND CONCLUSION: All patients were followed up for 12.8 months averagely. Fractures achieved clinical healing standard. No complications appeared. Recovery conditions of knee joint function are as follows: excellent in 25 cases, good in 9 cases, average in 2 cases, and poor in 1 case, with excellent and good rate of 92%. Results confirmed that after anterior lateral incision combined with posteromedial incision + tibia lateral “bamboo raft” steel plate and posteromedial support steel plate fixation in the treatment of tibial plateau fractures involving in posteromedial column of tibial plateau using artificial bone graft obtained good therapeutic effects.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Tissue Engineering, Tibia, Fractures, Bone, Biomechanics

CLC Number:

R318

Han Zhi-wei, Zhao Jie, Xin Jie . Complex tibial plateau fractures involving posteromedial column: implantation of “bamboo raft” plate and posteromedial support plate[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1416-1422.

Figures/Tables 1

2.1 受试者数量和基线分析 37例患者，其中男29例，女8例，年龄21-59岁，平均39.3岁。致伤原因中车祸23例，重物压砸14例。所有患者均随访12个月以上，均进入结果分析，无脱失值。 2.2 受试者随访结果患者37例固定后随访结果见表1。患者37例固定后即刻和固定后12个月相比胫骨平台内翻角、胫骨平台后倾角、Merchant评分标准和活动度均差异无显著性意义(P > 0.05)。 2.3 固定后膝关节恢复情况及功能评估结果 37例手术患者均获随访，随访时间超过12个月，平均12.8个月。固定后即刻行X射线片检查，37例胫骨平台骨折均获解剖复位，内固定安放位置良好，36例刀口Ⅰ期愈合，1例植骨排异反应经对症处理后切口Ⅱ期愈合，无下肢静脉血栓形成等并发症出现。固定后1，3，12个月行X射线片检查观察患者无骨折延迟愈合或不愈合、内固定松动断裂等症状。固定后完全负重时间为(3.9±0.5)个月。固定后1年膝关节屈曲(126±10.5)°，伸膝(1.3±2.2)°。本组随访后评分结果：优25例，良9例，可2例，差1例，优良率92%。所有患者固定后即刻胫骨平台内翻角及胫骨平台后倾角度数与固定后12个月相比，差异均无显著性意义(P > 0.05，表1)。 2.4 典型病例患者男，44岁，车祸伤致右膝关节损伤，固定前右膝关节CT三维重建示胫骨平台后内侧柱完全断裂、移位明显，诊断为右侧累及后内侧柱的胫骨平台骨折，行外侧竹筏型钢板加后内侧支撑钢板内固定复位骨折块，并行骨诱导人工骨植骨。固定后3 d X射线片示关节面高度恢复，力线恢复(图1)。2.5 不良反应分析 36例切口Ⅰ期愈合，1例植骨排异反应经对症处理后切口Ⅱ期愈合，无下肢静脉血栓形成等并发症出现。"

References

[1] 王年芳,谭振华,韩明涛.锁定钢板内固定治疗股骨髁部骨折[J].中国骨与关节损伤杂志,2009,24(2):177-178.
[2] 谢水华,胡前芹,吴摇军,等.关节镜辅助下手术治疗胫骨平台骨折[J].临床骨科杂志,2011,14(2):180.
[3] Laoruengthana A,Jarusriwanna A. Sensitivity and specificity of magnetic resonance imaging for knee injury and clinical application for the Naresuan University Hospital. J Med Assoc Thai. 2012;95 Suppl 10:S151-157.
[4] 魏尧森,张立岩,刘斌,等.锁定钢板内固定治疗胫骨平台骨折[J].临床骨科杂志,2011,14(2):143-144.
[5] 罗从风,姜锐,仲飙,等.经后侧入路支撑钢板固定治疗胫骨平台后侧劈裂骨折[J].中华创伤骨科杂志,2007,9(1):6-9.
[6] Goulet JA, SenunasLE, Desilva GL, et al. Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop. 1997;(339):76-81.
[7] 杨连发,岳得波,李中实,等.人工骨在治疗胫骨平台骨折中的应用[J].中国矫形外科杂志, 2004,12(12):892-894.
[8] 刘岗,张进禄,周东升等.胫骨平台骨折的治疗和固定后并发症的预防[J].中国矫形外科杂志,2003,11(Z2):1309-1311.
[9] 罗从风,胡承方,高洪,等.基于CT的胫骨平台骨折的三柱分型[J].中华创伤骨科杂志,2009,11(3):201-205.
[10] Merchant TC, Dietz FR. Long-term follow-up after fractures of the tibial and fibular shafts. J Bone Joint Surg. 1989;71(4): 599-606.
[11] 郭永智,刘智,孙天胜,等.复杂胫骨骨折的手术治疗[J].中国骨与关节外科,2009,2(2):40-43.
[12] Muller ME, Allgower M, Schneider R, et al. Manual of internal fixation. Berlin Springer Verlag. 1979;256-258.
[13] 齐斌,张满江,王亚军,等.胫骨平台骨折解剖与非解剖复位的实验研究与临床观察[J].骨与关节损伤杂志,1997,12(4):214-217.
[14] Muller ME, Nazarian S, Koch P. Classification AO des fractures. Springer. 1987.
[15] Wicky S, Blaser PF, Blanc CH, et al. Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol. 2000;10(8):1227-1232.
[16] Macarini L, Murrone M, Marini S, et al. Tibial plateau fractures: evaluation with multidetector-CT. La Radiol Med. 2003;108 (5-6): 503-514.
[17] Stahel PF, Smith WR, Morgan SJ. Posteromedial fracture fragments of the tibial plateau: an unsolved problem? J Orthopaedic Trauma. 2008;22(7):504.
[18] Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthopaedic Trauma. 2005;19(2):73-78.
[19] Bhattacharyya T, McCarty III LP, Harris MB, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthopaedic Trauma. 2005;19(5):305-310.
[20] 庞涛,孙锋,郭燕芬,等.前外侧联合后内侧手术入路治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折疗效观察[J].中国矫形外科杂志,2013,22(6):564-567.
[21] Barei DP, O'Mara TJ, Taitsman LA, et al. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthopaedic Trauma. 2008;22(3):176-182.
[22] Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthopaedic Trauma. 2005;19(2):73-78.
[23] 张贵林,荣国威,吴新宝,等.胫骨平台骨折手术复位效果不佳的原因分析[J].中华骨科杂志,2000,20:219-221．
[24] Liu Z, Li G, Yang Y, et al. Three-column plate internal fixation for the treatment of complex tibial plateau fracture through antero-midline and postero-medial approaches. Zhongguo Gu Shang. 2014;27(11):961-964.
[25] Bei C, Wang R, Tang J, et al. Effect factors analysis of knee function recovery after distal femoral fracture operation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009;23(9): 1053-1057.
[26] Ma HT, Bi DW, Chen YM, et al. Treatment of fractures of tibia intercondylar eminence under arthroscopy using suture anchors. Zhongguo Gu Shang. 2008;21(3):176-178.
[27] Saridis A, Panagiotopoulos E, Tyllianakis M,et al. The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss. J Bone Joint Surg Br. 2006;88(2):232-237.
[28] Svensson M, Sernert N, Ejerhed L, et al. A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients.Knee Surg Sports Traumatol Arthrosc. 2006;14(3): 278-286.
[29] Segal D. Displaced ankle fractures treated surgically and postoperative management. Instr Course Lect. 1984;33: 107-117.
[30] 赵光复,葛京化,谢可永.动静结合治疗骨折的实验研究[J].中国中医骨伤科杂志,1992,8(2):6.
[31] 赵善明,张健荣,李锦荣,等.58例胫骨平台骨折的手术治疗[J].中华创伤杂志,2003,19(10):620-622.