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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Comparison of articular exposure through extended lateral approaches to the tibial plateau
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Comparison of articular exposure through extended lateral approaches to the tibial plateau

机译：胫骨平台延伸侧向方法的关节曝光比较

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Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p & 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p&0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p & 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.
机译：目的与目标：粉碎的侧胫高原裂缝对外科医生构成挑战，导致所有病例中70-89％的非解剖减少。解剖学重建需要在减少片段减少后的关节直接可视化，这是使用常见的前外侧方法损害的。虽然描述了许多横向延伸方法，但目前没有关于哪种方法提供了后侧胫骨平台的更好可见性。本研究的目的是评估，可以通过使用外侧股骨髁骨膜切开术或腓骨骨质术来可视化哪些部分胫骨平台？此外，该研究研究了侧向侧侧韧带（LCl）和Popliteus肌腱（PLT）的股骨脚印的组合骨质术提供了比股骨LCL足迹的孤立的截骨术或腓骨骨质术的孤立的截骨术，提供了更好的前后关节表面。材料和方法：在十二人尸体膝关节上进行延伸的横向（股骨或腓骨LCL骨质图）和后侧（PLT肌腱的额外股骨骨质术）。在制备每个手术方法后，可见的关节表面标有透法。胫骨平台毫无纯粹，并用开源处理软件以数字方式测量标记。用成对的T检验测试平均值的差异（P <0.05）。结果：与LCl和PLT的截端术（P <0.001）的截骨术（P <0.001）实现，腓骨骨质图（1011.52±227.05mm 2）实现了最大的关节探测（1011.52±227.05mm 2 [86.64±4.84％]。包括PLT的LCL（937.45±237.84 mm 2 [80.29±8.25％]）暴露于侧胫高原的明显更大的关节表面而不是PLT（755.71±183.06mm 2 [64.73±6.51％]，p <0.001） 。结论：与股骨头LCL和PLT附件的侧面髁骨骨切断术相比，腓骨骨质术提供了侧胫骨平台的最大关节可见度。这种小益处应严重平衡，与腓骨截骨术引起的相当大的软组织损伤。包括LCL和PLT的侧向股骨髁骨骨膜切开术增加了横向关节可视化，而没有风险的神经血管或后侧软组织结构，并且代表了重要的exe Nded方法处理粉碎的横向高原骨折。

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