EFFECTIVENESS OF OPEN REDUCTION AND INTERNAL FIXATION WITHOUT OPENING JOINT CAPSULE ON TIBIAL PLATEAU FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENQi ,  XUXiaofeng , HUANGYonghui , CAOXingbing , MENGChen , CAOXueshu , WEIChangbao

No. 2 Department of Orthopedics, Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu, 212001, P. R. China;

Corresponding?author：

XUXiaofeng, Email: jackiechanoth@163.com

Keywords：

Tibial plateau fracture; Open reduction; Joint capsule; Internal fixation of fracture

DOI：

10.7507/1002-1892.20140317

Video：

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Objective To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. Methods Between July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, incision length, incision heal ing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. Results The intraoperative blood loss in trial group was significantly less than that in control group (P<0.05). The incision length in trial group was significantly shorter than that in control group (P<0.05). Difference was not significant in operation time and the rate of incision heal ing between 2 groups (P>0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture heal ing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P>0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). Conclusion It can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without opening joint capsule can avoid joint stiffness and obtain better joint function.

Citation： CHENQi, XUXiaofeng, HUANGYonghui, CAOXingbing, MENGChen, CAOXueshu, WEIChangbao. EFFECTIVENESS OF OPEN REDUCTION AND INTERNAL FIXATION WITHOUT OPENING JOINT CAPSULE ON TIBIAL PLATEAU FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1464-1468. doi: 10.7507/1002-1892.20140317 Copy

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10.	趙愛軍, 魏學慶, 盧吉高, 等. 伴后外側平臺塌陷的SchatzkerⅤ/Ⅵ型脛骨平臺骨折治療. 中國修復重建外科雜志, 2013, 27(5):639-640.
11.	Onoda Y, Hagiwara Y, Ando A, et al. Joint haemorrhage partly accelerated immobilization-induced synovial adhesions and capsular shortening in rats. Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
12.	Lin S, Mauffrey C, Hammerberg EM, et al. Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol, 2014, 24(5):797-803.
13.	徐云欽, 李強, 申屠剛, 等. 復雜脛骨平臺骨折手術時機與手術方式選擇及療效分析. 中國骨與關節損傷雜志, 2013, 28(4):320-323.
14.	Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res, 1993, (292):87-100.
15.	鄒華章, 馬曉春, 唐程, 等. 復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究. 中國修復重建外科雜志, 2013, 27(7): 855-859.
16.	王紅川, 樓華, 劉凱, 等. 改良外側脛骨平臺骨折塌陷關節面復位方法的療效觀察. 中國修復重建外科雜志, 2013, 27(1):12-16.
17.	Massé JP, Glimet T, Alpérovitch A, et al. Value of the femorotibial angle in 244 patients without knee arthrosis. Rev Rhum Mal Osteoartic, 1985, 52(2):91-94.
18.	Ghazavi MT, Paitzker KP, Davis AM, et al. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg (Br), 1997, 79(6):1008-1013.
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1. ?Ruedi TP, Murphy WM, Moran CG. 骨折治療的AO原則. 2版. 危杰, 劉璠, 吳新寶, 等譯. 上海:上海科技出版社, 2010:58-61.
2. 李衛康, 戚浩天, 趙永杰, 等. 影響股骨髁間骨折術后膝關節功能的相關因素分析. 中國矯形外科雜志, 2013, 21(24):2443-2448.
3. 丁宏. 閉合復位及經皮空心螺釘內固定治療脛骨平臺骨折. 中國醫學工程, 2012, 20(11):165, 169.
4. Chiu CH, Cheng CY, Tsai MC, et al. Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct. Arthroscopy, 2013, 29(8):1346-1354.
5. Lee HJ, Jung HJ, Chang EC, et al. Second-look arthroscopy after surgical treatment of Schatzker type Ⅱ plateau fractures through the lateral submeniscal approach. Arch Orthop Trauma Surg, 2014, 134(4): 495-499.
6. 沈光銀, 周建中. 關節鏡輔助經皮內固定和切開復位內固定治療Schatzker Ⅱ、Ⅲ型脛骨平臺骨折的比較研究. 中國修復重建外科雜志, 2011, 25(10):1201-1204.
7. Solomon LB, Stevenson AW, Lee YC, et al. Posterolateral and anterolateral approaches to unicondylar posterolateral tibial plateau fractures: a comparative study. Injury, 2013, 44(11):1561-1568.
8. Berber R, Lewis CP, Copas D, et al. Postero-medial approach for complextibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury, 2014, 45(4):757-765.
9. Johnson EE, Timon S, Osuji C. Surgical technique:Tscherne-Johnson extensile approach for tibial plateau fractures. Cl in Orthop Relat Res, 2013, 471(9):2760-2767.
10. 趙愛軍, 魏學慶, 盧吉高, 等. 伴后外側平臺塌陷的SchatzkerⅤ/Ⅵ型脛骨平臺骨折治療. 中國修復重建外科雜志, 2013, 27(5):639-640.
11. Onoda Y, Hagiwara Y, Ando A, et al. Joint haemorrhage partly accelerated immobilization-induced synovial adhesions and capsular shortening in rats. Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
12. Lin S, Mauffrey C, Hammerberg EM, et al. Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol, 2014, 24(5):797-803.
13. 徐云欽, 李強, 申屠剛, 等. 復雜脛骨平臺骨折手術時機與手術方式選擇及療效分析. 中國骨與關節損傷雜志, 2013, 28(4):320-323.
14. Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res, 1993, (292):87-100.
15. 鄒華章, 馬曉春, 唐程, 等. 復合型可注射磷酸鈣骨水泥在脛骨平臺塌陷骨折中的生物力學研究. 中國修復重建外科雜志, 2013, 27(7): 855-859.
16. 王紅川, 樓華, 劉凱, 等. 改良外側脛骨平臺骨折塌陷關節面復位方法的療效觀察. 中國修復重建外科雜志, 2013, 27(1):12-16.
17. Massé JP, Glimet T, Alpérovitch A, et al. Value of the femorotibial angle in 244 patients without knee arthrosis. Rev Rhum Mal Osteoartic, 1985, 52(2):91-94.
18. Ghazavi MT, Paitzker KP, Davis AM, et al. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. J Bone Joint Surg (Br), 1997, 79(6):1008-1013.
19. Thompson JC. 奈特簡明骨科學彩色圖譜. 邱貴興, 高鵬, 譯. 北京: 人民衛生出版社, 2011:229.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF OPEN REDUCTION AND INTERNAL FIXATION WITHOUT OPENING JOINT CAPSULE ON TIBIAL PLATEAU FRACTURE

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