Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Return to sport following tibial plateau fractures: A systematic review

AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management(n = 3); 27 reported on the outcome of surgical management(n = 917). Nine studies reported on Open Reduction Internal Fixation(ORIF)(n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation(ARIF)(n = 253) and 7 on Frame-Assisted Fixation(FRAME)(n = 262). All studies recorded "return to sport"rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF(OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME(OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME(OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo(median), from a study reporting on ORIF.CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.

Locking compression plate+T-type steel plate for postoperative weight bearing and functional recovery in complex tibial plateau fractures

Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients.The anatomical relationship between the proximal tibial bone and soft tissue is complex,resulting in different types of tibial plateau fractures.Violent trauma can lead to displaced fracture,serious soft tissue injury,and potentially,dislocation of the knee joint.Therefore,tibial plateau fractures are extremely unstable.AIM To assess the use of locking compression plate(LCP)+T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study.Forty-nine patients had been treated with LCP+T-type steel plate limited internal fixation(study group),and 48 patients with bilateral ordinary steel plate support(control group).The operation process index,postoperative rehabilitation related index,Rasmussen score of the knee joint,tibial plateau varus angle(TPA),tibial plateau retroversion angle(PA),and surgical complications of the two groups were compared.RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group(P<0.05).There were no significant differences in surgical bleeding,anterior external incision length,postoperative drainage,hospital stay duration,and fracture healing time between the groups(P>0.05).There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery(P>0.05).At 12 mo after surgery,the Rasmussen scale score was higher in the study group than in the control group(P<0.05).There was no significant difference in the Rasmussen scale score at 18 mo after surgery,and the radiology score at 12 and 18 mo after surgery,between the two groups(P>0.05).The postoperative complication rate in the study group(3.77%)was lower than that in the control group(15.09%;P<0.05).CONCLUSION LCP+T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise,promoting functional recovery and lower limb weight-bearing,and reducing postoperative complications.

Medial tibial plateau morphology and stress fracture location:A magnetic resonance imaging study

AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging(MRI).METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years(range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI.RESULTS Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially(AM type), six posteromedially(PM type), and five posteriorly(P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI.CONCLUSION We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

The Application and Operation-Effect Analysis for Complex Tibial Plateau Fractures with 3D Printing Technique

Objective: To investigate the value of 3D printing techniques in the treatment of complex tibial plateau fractures. Methods: From September 2016 to September 2018, 28 patients with complex tibial plateau fractures were treated in our hospital. According to the odevity of hospitalized order, the patients were divided into two groups. Group A used 3D reconstruction, virtually reduction, 3D printing and demonstration of individual fracture model before operation while group B only received conventional process by use X-rays or CT image. Comparison between the two groups was made in operation time, operative blood loss, radiation frequency, surgery instrument cost and knee function score. Results: The follow-up was 14.4 months on average (ranged 6 to 22 months). There was no statistical difference of the surgery instrument cost between the 2 groups (P > 0.05). The operation time of group A was significantly shorter than that of group B (P χ2 = 0.373, P = 0.54). Conclusion: 3D printing techniques can improve surgery effect in complex tibial plateau fractures.

Artificial Intelligence to Diagnose Tibial Plateau Fractures: An Intelligent Assistant for Orthopedic Physicians

Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.

Combined Use of Percutaneous Canulated Screws and External or Internal Fixation for Less Invasive Treatment of Tibial Plateaux Fractures

The classic way of treatment of tibial plateau fractures with an extensive approach, opening of the knee and compressive internal fixation can lead to major complications such as infection, skin necrosis and knee stiffness. Here we present a less invasive and thus safer surgical technique, and its indications and results. Twenty patients with various types of fractures according to Schatzker’s classification (mainly V and VI) were treated during a time period of seven years. Surgical treatment usually consisted of a combination of percutaneous canulated screws with a hybrid external fixator. In three cases canulated screws were combined with a laterally applied anatomic locking plate. Patients were followed up for six months to three years postoperatively. Indications as well as intra and postoperative parameters such as surgical time, stability of fixation, blood loss, wound healing, infection, fracture healing and final result were studied. No major complications were recorded either early or later. The use of external οr less invasive internal fixation in combination with percutaneous canulated screws appears to be an adequate method for the treatment of most types of these fractures.

Lesional and Therapeutic Aspects of Tibial Plateau Fractures at the BSS University Hospital Center in Kati

Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.

PERCUTANEOUS REDUCTION AND STABILIZATION OF COMPLEX TIBIAL PLATEAU FRACTURES

Mechanical traction and percutaneous reduction by leverage and fixation by a bilateral groove externalfixator were performed on 23 patients with complex tibial plateau fractures involving a depressed and splitfragments. The fixator is composed of two long groove frames, three to five nuts, hooked bolts and Stein-manns pins.All fractures united in good position in three months with no incision (only pinpricks), llttle operativetrauma and no significant complications but pintract infection, and the flexion-extension range of kneemovement was excllent in all patients, so that this technique is particularly advisable for complex tibialplateau fractures.

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

BACKGROUND Tibial plateau fracture is one of the common fracture types.It occurs mainly in teenagers and is usually caused by a fall.After the occurrence of fracture,knee swelling,pain,limited activity,etc.greatly affect the patient’s exercise habits and lifestyle.X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)were used in this examination.X-rays are relatively new and easy to operate.However,there are some errors in the observation of fracture collapse and fracture displacement.In recent years,CT and MRI have been actively used to diagnose various types of clinical fractures.They have more diagnostic power than X-ray film.However,some scholars believe that CT is also prone to errors in clinical application.The volume effect leads to missed diagnosis and misdiagnosis in some cases,while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT.To facilitate the selection of clinical examination regimens,this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures.AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures.METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included.All patients were examined by nuclear MRI and CT scanning.The results were sent to senior physicians in our hospital to complete the diagnosis.RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects:fracture displacement,bone defect,fracture site and fracture comminution.There was no significant difference in the score data(P>0.05).Nuclear magnetic resonance and CT tended to be consistent in the B3,C2 and C3 fracture diagnosis coincidence rate,combined injury detection rate and fracture detection rate.The diagnostic coincidence rate of type B1,B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT(P>0.05).CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures,but MRI is more accurate and may be preferred.

术前MSCT对胫骨平台骨折伴半月板损伤的诊断价值

目的探讨术前多层螺旋计算机断层扫描(MSCT)对胫骨平台骨折伴半月板损伤的诊断价值。方法回顾2017年1月至2022年12月聊城市第二人民医院收治的83例行胫骨平台骨折内固定术治疗病人的临床资料,术前均接受MSCT检查,以术中骨折复位内固定后即刻关节镜下所见有无发生半月板损伤为金标准分为半月板损伤组和无半月板损伤组。比较两组病人基线资料及MSCT参数,绘制受试者操作特征曲线(ROC曲线)分析MSCT参数对复杂胫骨平台骨折伴半月板损伤的诊断价值。结果83例胫骨平台骨折病人发生半月板损伤共39例(46.99%),Ⅳ型半月板损伤发生率为18.75%(3/16),低于Ⅱ型的59.52%(25/42)(P<0.05)。半月板损伤组中SchatzkerⅡ型占比高于无半月板损伤组,SchatzkerⅣ型占比及术前MSCT检测骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积高于低于无半月板损伤组(P<0.05)。ROC曲线分析显示,骨折切线至塌陷最低点距离、外侧髁切线至骨折块远端距离、塌陷相对面积单独及联合应用诊断胫骨平台骨折伴半月板损伤的ROC曲线下面积(AUC)(95%CI)为0.64(0.56,0.72)、0.70(0.62,0.78)、0.76(0.67,0.83)、0.89(0.83,0.94),联合应用的诊断价值高于单独应用(P<0.05)。结论术前MSCT测量胫骨平台骨折外侧髁切线至骨折块远端距离、塌陷相对面积等参数对半月板损伤的诊断有重要参考价值。

后外侧胫骨平台骨折应用万向螺钉的有限元分析

背景:通过腓骨头上入路治疗后外侧胫骨平台骨折时,腓骨头与外侧平台间隙差无法满足所有患者行钢板后置。目的:有限元法分析腓骨头上入路治疗后外侧胫骨平台骨折过程中钢板横臂万向螺钉角度以及数量不同导致固定强度的差异。方法:选用一名30岁健康成年男性志愿者膝关节至踝关节的CT图像,建立有限元模型。根据外侧锁定加压钢板是否后置分为后置组和非后置组,后置组根据2枚万向螺钉的偏移角度分为A-D组(0°,5°,10°,15°);非后置组根据2枚万向螺钉的偏移角度分为E,F组(0°,15°)。采用有限元法评估250,500,750 N载荷下的von Mises应力分布、最大von Mises应力和压缩位移,探究各组之间的力学差异。结果与结论:①有限元分析结果显示:750 N载荷水平下,内固定装置的最大压缩位移趋势为D<B=C=F<A<E,最大von Mises应力趋势为B<C<A<D<F<E,骨的最大压缩位移趋势为C=D<B<A<F<E,最大von Mises应力趋势为B<C<A<F<D<E;6组模型在250-750 N的位移和应力趋势相似;②提示通过腓骨头上入路固定后外侧胫骨平台骨折,应尽量满足钢板后置2枚螺钉固定;当术中后置钢板仅满足1枚螺钉固定时,可使用万向螺钉在0°-15°范围内后偏,增加2枚螺钉的固定概率。

胫骨平台骨折术前下肢深静脉血栓形成列线图预测模型构建与验证

目的 探讨胫骨平台骨折患者术前发生下肢深静脉血栓(DVT)的危险因素,构建风险预测模型并验证。方法 回顾性分析2018年1月—2024年1月攀枝花市中心医院骨科收治的胫骨平台骨折患者166例,男性108例,女性58例;年龄22~76岁,平均49.3岁;摔伤69例,道路交通伤64例,高处坠落伤33例。SchatzkerⅠ~Ⅲ型91例,SchatzkerⅣ~Ⅵ型75例。根据术前下肢深静脉彩色多普勒超声结果将患者分为DVT组(50例)和非DVT组(116例)。通过单因素分析和多因素Logistic回归分析确定术前发生DVT的独立危险因素,根据独立危险因素构建列线图预测模型,绘制受试者工作特征(ROC)曲线,校准曲线和临床决策分析(DCA)曲线验证该模型的预测效能。结果 166例患者中术前检出DVT50例,术前DVT发生率30.1%(95%CI:0.231~0.372)。单因素分析结果显示,年龄、致伤因素、受伤至手术时间和术前D-二聚体比较差异有统计学意义(P<0.05),多因素Logistic回归分析结果显示,年龄≥47.5岁和术前D-二聚体≥2422.5ng/mL是胫骨平台骨折患者术前发生DVT的独立危险因素。ROC曲线显示,该模型曲线下面积(AUC)为0.960,95%CI:0.929~0.991,灵敏度为88.0%,特异度为95.6%,校准曲线显示该模型一致性良好,DCA曲线显示在阈值范围0~1中该模型临床净收益均较高。结论 年龄≥47.5岁、术前D-二聚体≥2422.5ng/mL为胫骨平台骨折患者术前发生DVT的独立危险因素。由此构建的模型具有较好的区分度和一致性,应用于胫骨平台骨折术前DVT的预测具有较好的预测效能。

关节镜辅助下MIPPO技术结合锁定钢板治疗SchatzkerⅢ型胫骨平台骨折的临床研究

目的:探讨关节镜辅助下微创经皮钢板固定(MIPPO)技术结合锁定钢板治疗SchatzkerⅢ型胫骨平台骨折(TPF)的临床效果。方法:按随机数字表法将2020年1月—2023年1月瑞昌市人民医院收治的80例SchatzkerⅢ型TPF分为两组,各40例,对照组给予锁定钢板内固定治疗,联合组给予关节镜辅助下MIPPO技术结合锁定钢板内固定治疗。对比两组并发症发生情况、炎症反应[白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、恢复情况、关节功能[美国足与踝关节协会(AOFAS)踝-后足评分系统评分、美国特种外科医院(HSS)膝关节评分]。结果:与对照组相比,联合组并发症发生率低,差异有统计学意义(P<0.05)。术前两组IL-1β、TNF-α、CRP水平比较,差异均无统计学意义(P>0.05);与对照组相比,联合组术后IL-1β、TNF-α、CRP水平均低,差异均有统计学意义(P<0.05)。与对照组相比,联合组骨折愈合时间、负重时间均早,差异均有统计学意义(P<0.05)。术前两组AOFAS踝-后足评分系统、HSS膝关节评分比较,差异均无统计学意义(P>0.05),与对照组相比,联合组术后AOFAS踝-后足评分系统、HSS膝关节评分均高,差异均有统计学意义(P<0.05)。结论:关节镜辅助下MIPPO技术结合锁定钢板治疗SchatzkerⅢ型TPF利于减少术后并发症发生,降低炎症反应,促进骨折愈合,缩短负重时间,提升踝关节、膝关节功能。

虚拟手术系统联合个体化导航模板在复杂胫骨平台骨折中的应用

目的 分析虚拟手术系统联合个体化导航模板在复杂胫骨平台骨折(TPF)中的应用效果。方法 选取2021年5月至2022年12月我院收治的60例复杂TPF患者,随机分为对照组和观察组,每组30例。2组均行切开复位钢板内固定治疗,对照组患者采用传统手术计划方案治疗,观察组患者采用虚拟手术系统联合个体化导航模板的手术计划方案治疗。比较2组患者骨折复位优良率、手术相关指标、膝关节活动度、膝关节功能、并发症发生率。结果 与对照组比较,观察组患者出血量、术中C型臂透视次数减少(P<0.05),住院时间、骨折愈合时间及手术时间缩短(P<0.05);观察组患者骨折复位优良率高于对照组(P<0.05);与对照组比较,观察组患者术后3个月、6个月膝关节屈曲度、伸展度较大(P<0.05);观察组患者术后3个月、6个月的膝关节协会评分标准(KSS)、纽约特种外科医院(HSS)评分高于对照组(P<0.05);观察组患者并发症发生率低于对照组(P<0.05)。结论 复杂TPF患者切开复位钢板内固定治疗中采用虚拟手术系统联合个体化导航模板能明显提高手术效率,减少手术创伤及并发症,促进患者术后康复,提高骨折复位质量,改善预后。

锁定钢板内固定并植骨治疗复杂胫骨平台骨折的效果

目的:探究锁定钢板内固定并植骨治疗复杂胫骨平台骨折(CTPF)的效果。方法:选取2021年8月—2023年8月贵州省建筑医院收治的94例CTPF患者。随机将其分为对照组和观察组,各47例。对照组给予锁定钢板内固定治疗,观察组给予锁定钢板内固定并植骨治疗。比较两组围手术期指标,术后即刻、术后3个月胫骨平台内翻角与后倾角,术前、术后3个月膝关节功能、生活质量及并发症。结果:观察组术中出血量多于对照组,手术时间长于对照组,开始负重时间和骨折愈合时间均早于对照组,差异有统计学意义(P<0.05)。术后3个月,两组胫骨平台内翻角、胫骨平台后倾角、美国特种外科医院膝关节功能(HSS)评分均升高,观察组胫骨平台内翻角、胫骨平台后倾角均小于对照组,HSS评分高于对照组,差异有统计学意义(P<0.05)。术后3个月,两组心理功能、躯体功能、社会功能、物质生活状态评分均升高,观察组心理功能、躯体功能、社会功能、物质生活状态评分均高于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:锁定钢板内固定并植骨可维持CTPF患者的膝关节平稳度,改善膝关节功能,提高生活质量,且无严重并发症。

膝关节镜下引导小切口与传统切开内固定治疗胫骨平台骨折的效果及对膝关节功能的影响

目的:探究膝关节镜下引导小切口与传统切开内固定治疗胫骨平台骨折(fracture of tibial plateau,FTP)的效果及对膝关节功能的影响。方法:回顾性分析2022年6月—2023年3月厦门市第五医院收治的60例FTP患者,按照膝关节镜下引导小切口和传统切开内固定手术方式差异分为研究组(28例)和传统组(32例)。两组患者均于术后随访3个月,观察两组围手术期指标(手术时间、术中出血量、下床活动时间、骨折愈合时间、住院时间),统计两组随访期间并发症发生率,比较两组术前、术后48 h炎症应激指标[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、皮质醇(cortisol,Cor)]及术前、术后3个月膝关节功能评分[采用美国特种外科医院膝关节评分(Hospital for Special Surgery knee score,HSS)、膝关节活动度(range of motion,ROM)]。结果:研究组手术时间显著长于传统组,术中出血量显著少于传统组,下床活动时间显著早于传统组,差异有统计学意义(P<0.05);两组骨折愈合时间、住院时间比较,差异无统计学意义(P>0.05);研究组并发症总发生率低于传统组,差异有统计学意义(P<0.05);术后48 h,两组IL-6、TNF-α、Cor水平均较术前显著升高,但研究组术后48 h的IL-6、TNF-α、Cor水平显著低于传统组,差异有统计学意义(P<0.05);术后3个月,两组HSS评分、ROM中伸膝和屈膝角度均较术前显著升高,且研究组HSS评分、ROM伸膝和屈膝角度高于传统组,差异有统计学意义(P<0.05)。结论:膝关节镜下引导小切口与传统切开内固定手术治疗FTP均能取得较好临床效果,但膝关节镜下引导小切口式更具微创优势,可减少术中出血量、缩短下床活动时间,且并发症发生率低,术后炎症及应激反应轻,膝关节活动功能恢复好,有利于患者康复。

超声引导下腰丛坐骨神经阻滞麻醉在老年胫骨平台骨折患者中的应用

目的:分析超声引导下腰丛坐骨神经阻滞麻醉在老年胫骨平台骨折患者中的应用。方法:选取2021年7月—2023年7月菏泽市定陶区人民医院诊治的80例胫骨平台骨折老年患者为研究对象,采用随机数表法将其分为对照组40例,观察组40例,对照组采用全身麻醉,观察组采用超声引导下腰丛坐骨神经阻滞麻醉。对比两组围手术期动脉血氧分压(PaO_(2))、舒张压(DBP)、收缩压(SBP)、心率(HR)、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]、认知功能及术后不良反应发生情况。结果:两组麻醉前PaO_(2)、DBP、SBP、HR比较,差异无统计学意义(P>0.05);麻醉后15 min、麻醉后45 min、手术结束即刻,观察组PaO_(2)、DBP、SBP、HR均较对照组高,差异有统计学意义(P<0.05)。两组手术结束即刻应激反应指标比较,差异无统计学意义(P>0.05);两组术后2 h Cor、NE、E较手术结束即刻下降,但观察组术后2 h Cor、NE、E较对照组低,差异有统计学意义(P<0.05)。观察组术后1 d认知功能评分优于对照组,差异有统计学意义(P<0.05);观察组术后不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:超声引导下腰丛坐骨神经阻滞麻醉相较于全身麻醉,不仅能够为老年胫骨平台骨折患者提供更加稳定的手术条件,还能减轻生理应激反应,同时对老年患者的认知功能影响更小,能降低术后不良反应发生风险。

Arthroscopically assisted treatment for Schatzker type Ⅰ-Ⅴ tibial plateau fractures

Objective： To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. Methods： A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type Ⅰ fracture, 12 type Ⅱ, 9 type Ⅲ, 12 type Ⅳ and 2 type Ⅴ according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. Results： All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation.No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthfitis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26 ± 3. Conclusions： As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures;15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion: Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.