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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Schatzker II tibial plateau fractures: Anatomically precontoured 3.5 mm locking compression plates allow for improved patient outcome
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Schatzker II tibial plateau fractures: Anatomically precontoured 3.5 mm locking compression plates allow for improved patient outcome

机译：Schatzker II胫骨平台骨折：解剖学上预先成型的3.5 mm锁定加压钢板可改善患者预后

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Aims and Objectives: In the operative treatment of split depression factures to the lateral tibial plateau, the reconstruction of the depressed joint surface is eagerly sought after. The subchondral bony defect often requires bone grafting or bone graft substitutes. At least equally important is the achievement of an internal fixation that provides the greatest possible support for the fragile joint surface fragments. The design of the anatomically precontoured locking compression plates features a higher number of locking screws underneath the joint surface and permits the screw placement closer to the subchondral zone compared to conventional plates. Whether the altered design results in better patient outcome is analysed in this study. Materials and Methods: Our databank was searched for Schatzker II fractures from 2012 until 2015. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm locking compression plates (A) or conventional 4,5 mm L-shaped locking compression plates and screws (B) were included and retrospectively evaluated. CT-scans, radiographs in two planes and in full length standing mode, if available, were analysed. Details of the operative procedures and secondary events were determined. Objective outcome parameters were collected from the patient records, subjective outcome parameters were assessed in a survey and WOMAC as well as Rasmussen functional knee scores were calculated. Results: A total of 36 patients were included (A=20, B=16). The mean patient age, the ratio male to female and the mean follow up were comparable. CT-scans revealed an equal mean size of the depressed joint surface (A: 23.7 x 25.3 mm; B: 23.9 x 24.0 mm) and maximal depression depth (11.2 and 11.8 mm). The duration of the operation, the frequency of utilizing bone grafts or bone graft substitutes and of lateral meniscus repair as well as the rate of subsequent implant removal were also comparable. In the early postoperative controls, the radiological assessment according to Rasmussen revealed a mean score of 9.1 (A) and of 8.5 (B). During follow up, the mean score decreased to 8.1 and 6.7 for A and B, respectively. This difference was statistically significant (p<0.05). A valgus deviation was more often observed in group B. Both, the WOMAC and the Rasmussen functional knee score revealed lower mean values for group B in the final evaluation. Conclusion: The progressive decrease of the Rasmussen radiological score for the conventional 4,5 mm L-shaped locking compression plates and screws was predominantly due to a secondary loss of reduction and an increasing valgus deviation. The altered design of the anatomically precontoured 3.5 mm locking compression plate seems to prevent more sufficiently the reduced joint surface fragments from sintering over time. The anatomically precontoured 3.5 mm locking compression plate allows for improved patient outcome and should closely be considered for internal fixation of split depression fractures to the lateral tibial plateau.
机译：目的和目的：在对胫骨平台外侧劈裂的凹陷骨折的手术治疗中，急切地寻求对凹陷的关节表面进行重建。软骨下骨缺损通常需要植骨或替代植骨。至少同样重要的是实现内部固定，该固定为脆弱的关节表面碎片提供了最大可能的支撑。解剖学轮廓的锁定加压板的设计在关节表面下方具有更多数量的锁定螺钉，并且与常规板相比，允许将螺钉放置在更靠近软骨下区域的位置。在这项研究中分析了更改后的设计是否会导致更好的患者预后。材料和方法：从我们的数据库中搜索2012年至2015年的Schatzker II骨折。对患者进行解剖复位的3.5 mm锁紧加压钢板（A）或常规的4,5 mm L形锁紧加压钢板和螺钉进行的切开复位和内固定（B）包括在内并进行回顾性评估。分析了CT扫描，两个平面上的X射线照片以及全长站立模式（如果有）。确定了手术程序和继发事件的细节。从患者记录中收集客观结果参数，在调查中评估主观结果参数，并计算WOMAC以及Rasmussen功能性膝关节评分。结果：共纳入36例患者（A = 20，B = 16）。平均患者年龄，男女比例和平均随访率是可比较的。 CT扫描显示凹陷面的平均大小相等（A：23.7 x 25.3毫米; B：23.9 x 24.0毫米），最大凹陷深度（11.2和11.8毫米）。手术的持续时间，使用骨移植物或骨移植物替代物的频率以及半月板修复的频率以及随后的种植体去除率也相当。在早期的术后控制中，根据拉斯穆森的放射学评估显示平均得分分别为9.1（A）和8.5（B）。在随访期间，A和B的平均得分分别降至8.1和6.7。这种差异具有统计学意义（p <0.05）。在B组中更经常观察到外翻偏差。在最终评估中，WOMAC和Rasmussen功能性膝关节评分均显示B组的平均值较低。结论：常规的4,5 mm L形锁紧加压板和螺钉的Rasmussen放射学评分逐渐下降的主要原因是继发的复位损失和外翻偏差增加。解剖学上预先成型的3.5 mm锁定加压板的更改设计似乎可以更充分地防止减少的关节表面碎片随时间烧结。解剖学上预先成型的3.5 mm锁定加压钢板可改善患者的预后，应密切考虑将劈裂性压迫性骨折内固定至胫骨外侧平台。

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