Abstract:Objective To investigate surgical outcome of tibial plateau fracture involved the posterior condylar which was guided by three columns theory of tibial plateau fracture.Methods Seventeen patients with tibial plateau fractures involved the posterior condylar treated in the Third Affiliated Hospital of Anhui Medical University from June 2011 to May 2013 were analyzed retrospectively, in which male 12 patients, female 5 patients, age 20-54 years old, average 33.8 years old; Schatzker fracture classification: Ⅰtype 2 patients, Ⅲ type 3 patients, Ⅳ type 3 patients, Ⅴ type 7 patients, Ⅵ type 2 patients, three columns fracture classification: Simple posterior column fracture 4 patients, posterior column fracture combined lateral column 4 cases, posterior column fracture combined medial column 2 patients, posterior column fracture combined lateral column and medial column fracture 7 patients. The "L" incision behind the knee joint was used for simple posterior column fracture or combined medial column fracture of tibial plateau, while the "L" incision and anterolateral incision of the knee joint were used for posterior column fracture combined lateral column or combined lateral and medial column fracture of tibial plateau. Knee X-ray was examined and the varus angle and posterior slope of tibial plateau were measured postoperatively, while knee Rasmussen function score was assessed postoperatively.Results Seventeen patients were received more than 1 year follow-up, all tibial plateau fractures were healed, in which there were no complication of infection, skin necrosis, loosening and breakage of internal fixation. The mean varus angle of tibial plateau in patients was 86.27°±0.35° postoperatively, and it was 86.39°±0.32° at 1 year after operation(t=0.940). The mean posterior slope of tibial plateau was 9.15°±0.34° postoperatively, and it was 9.17°±0.34° at 1 year after operation(t=0.687). There were no significant differences in the varus angle and posterior slope of tibial plateau between 1 year after operation and immediate postoperative (all P values >0.05). The total fine rate of 17 patients in knee Rasmussen function score was 16/17 at 1 year after operation.Conclusions Three column theory of tibial plateau fracture is a fine guidance in the surgical treatment to tibial plateau fractures involved the posterior condylar, the "L" incision behind the knee joint or combined the auxiliary anterolateral incisions of the knee joint have the good exposure and corresponding fixation to the most tibia platfeau fracture involved the posterior condylar.
宁仁德,姚涛,孔令超,吕飞飞,周业金. 波及后髁的胫骨平台骨折的手术治疗[J]. 中华解剖与临床杂志, 2015, 20(5): 435-439.
Ning Rende, Yao Tao, Kong Lingchao, Lyu Feifei, Zhou Yejin. Surgical treatment of tibial plateau fractures involved the posterior condylar. Chinese Journal of Anatomy and Clinics, 2015, 20(5): 435-439.
Wang SQ, Gao YS, Wang JQ, et al. Surgical approach for high-energy posterior tibial plateau fractures[J]. Indian J Orthop, 2011,45(2):125-131.
[2]
Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, et al. Complications after tibia plateau fracture surgery[J]. Injury, 2006, 37(6): 475-484.
[3]
Sohn HS, Yoon YC, Cho JW, et al. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures[J]. J Orthop Trauma , 2015, 29(2): 91-97.
[4]
Yang G, Zhai Q, Zhu Y, et al. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system[J]. Arch Orthop Trauma Surg, 2013,133(7): 929-934.
He X, Ye P, Hu Y, et al. A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures[J]. Arch Orthop Trauma Surg, 2013, 133(1): 23-28.
[7]
De Boeck H, Opdecam P. Posteromedial tibial plateau fractures. Operative treatment by posterior approach[J]. Clin Orthop Relat Res, 1995, (320):125-128.
[8]
Bendayan J, Noblin JD, Freeland AE. Posteromedial second incision to reduce and stabilize a displaced posterior fragment that can occur in Schatzker Type V bicondylar tibial plateau fractures[J]. Orthopedics, 1996, 19(10): 903-904.
[9]
Chang SM, Zheng HP, Li HF, et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation[J]. Arch Orthop Trauma Surg, 2009,129(7): 955-962.
[10]
Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach[J]. Knee, 2008,15(6):473-479.
[11]
Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study[J]. Injury, 2013, 44(11): 1561-1568.
[12]
Chen WT, Zhang YQ, Chang SM. Posterolateral approach for plating of tibial plateau fractures and the risk of injury to the anterior tibial vessels[J]. J Orthop Trauma, 2013, 27(9): e228-e229.
[13]
Ziran BH, Hooks B, Pesantez R. Complex fractures of the tibial plateau[J]. J Knee Sur, 2007,20(1): 67-77.
[14]
Weaver MJ, Harris MB, Strom AC, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures[J]. Injury, 2012, 43(6): 864-869.
[15]
Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation?[J]. J Orthop Trauma, 2007, 21(5): 301-306.
[16]
Jiang R, Luo CF, Wang MC, et al. A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures[J]. Knee, 2008,15(2): 139-143.
[17]
Weimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study[J]. BMC Musculoskelet Disord, 2013,14:120.
[18]
Ruffolo MR, Gettys FK, Montijo HE, et al. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions[J]. J Orthop Trauma, 2015, 29(2): 85-90.
[19]
Lobenhoffer P. Posterolateral transfibular approach to tibial plateau fractures[J]. J Orthop Trauma, 2011,25(3):e31.
[20]
Yu B, Han K, Zhan C, et al. Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures[J]. Knee, 2010,17(5):313-318.