Open reduction and internal fixation with plate via posteromedial approach of retaining pes anserinus tendon in the treatment of tibial plateau fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Xinlong , CI Wentao , YAN Shi , LUO Kaiwen , YAN Shuai , ZHANG Qingzhu , YIN Xuelian ,  ZHANG Yi

Department of Trauma Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde Hebei, 067000, P. R. China;

Corresponding?author：

ZHANG Yi, Email: 120629090@qq.com

Keywords：

Tibial plateau fracture; pes anserinus tendon; soft tissue injury; knee range of motion; complication

DOI：

10.7507/1002-1892.202104066

Video：

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Objective To compare the effects of cutting and retaining the pes anserinus tendon on effectiveness following tibial plateau fracture. Methods A clinical data of 40 patients with tibial plateau fracture treated with open reduction and internal fixation with plate via posteromedial approach between January 2015 and January 2020 was retrospectively analyzed, including 18 patients retained the pes anserinus tendon (study group) and 22 patients cut the pes anserinus tendon (control group) during operation. There was no significant difference in gender, age, side of affected knee, cause of injury, Schatzker classification, time from injury to operation, and associated ligament injury between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, anatomic reduction rate, incidence of complications, fracture healing time, knee flexion and extension range of motion at 2 weeks and 12 months, and knee extension range of motion at 3 months after operation were recorded and compared between the two groups. The visual analogue scale (VAS) score was used to evaluate the early postoperative pain improvement at 1, 3, and 14 days after operation and hospital for special surgery (HSS) score was used to evaluate the improvement of knee function at 3, 6, and 12 months after operation. Results The patients in both groups were followed up 12-15 months with an average of 12.8 months. There was no significant difference in operation time, intraoperative blood loss, and fracture healing time between the two groups (P>0.05). The hospital stay in the control group was significantly longer than that in the study group (t=8.339, P=0.000). There was no significant difference in the anatomic reduction rate (90.9% vs. 83.3%) between the control group and the study group (χ²=0.058, P=0.810). There were 1 case of proximal tibial osteomyelitis, 3 cases of skin necrosis, 3 cases of traumatic arthritis, and 2 cases of lower deep venous thrombosis after operation in the control group, and 1 case of metaphyseal nonunion, 2 cases of traumatic arthritis, and 1 case of lower deep venous thrombosis in the study group, showing no significant difference in the incidence of complications (40.9% vs. 22.2%) between the two groups (χ²=1.576, P=0.209). In the study group, knee flexion and extension range of motion at 2 weeks and 12 months and knee extension range of motion at 3 months after operation were significantly better than those of the control group (P<0.05). VAS scores and HSS scores in both groups improved with time after operation (P<0.05), in addition, the HSS score and VAS score of the study group were significantly better than those of the control group (P<0.05). Conclusion Compared with traditional pes anserinus tendon cutting group, pes anserinus tendon retaining group can significantly reduce postoperative short-term pain, improve postoperative knee range of motion and knee function within 1 year after operation.

Citation： ZHANG Xinlong, CI Wentao, YAN Shi, LUO Kaiwen, YAN Shuai, ZHANG Qingzhu, YIN Xuelian, ZHANG Yi. Open reduction and internal fixation with plate via posteromedial approach of retaining pes anserinus tendon in the treatment of tibial plateau fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 170-176. doi: 10.7507/1002-1892.202104066 Copy

1.	朱燕賓, 侯志勇, 金柱成, 等. 2010年至2011年華北五省市18所醫院脛骨平臺骨折流行病學調查研究. 中華創傷骨科雜志, 2020, 22(8): 682-686.
2.	Aurich M, Koenig V, Hofmann G. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. Asian J Surg, 2018, 41(2): 99-105.
3.	Toor AS, Limpisvasti O, Ihn HE, et al. The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2608-2616.
4.	Curtis BR, Huang BK, Pathria MN, et al. Pes Anserinus: Anatomy and pathology of native and harvested tendons. AJR Am J Roentgenol, 2019, 213(5): 1107-1116.
5.	劉超, 王鐵軍, 寧漱巖, 等. 老年脛骨平臺骨折術后并發癥和手術入路研究進展. 中國老年學雜志, 2018, 38(2): 507-509.
6.	袁亮, 呂揚, 周方. 脛骨平臺骨折患者術后生活質量的研究現狀. 中國組織工程研究, 2018, 22(19): 3097-3102.
7.	Yan B, Sun J, Yin W. The prevalence of soft tissue injuries in operative Schatzker type Ⅳ tibial plateau fractures. Arch Orthop Trauma Surg, 2021, 141(8): 1269-1275.
8.	Adams JDJ, Loeffler MF. Soft tissue injury considerations in the treatment of tibial plateau fractures. Orthop Clin North Am, 2020, 51(4): 471-479.
9.	馬凱. 內側入路治療脛骨平臺骨折時對鵝足不同處理方法的預后分析. 石家莊: 河北醫科大學, 2015.
10.	Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
11.	湯旭日, 王秋根, 張秋林, 等. 脛骨平臺骨折術后高度丟失的原因及對策. 中華創傷骨科雜志, 2004, 6(3): 24-27.
12.	Beisemann N, Vetter SY, Keil H, et al. Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study. Orthop Traumatol Surg Res, 2021. doi: 10.1016/j.otsr.2021.102922.
13.	Binazzi R, Soudry M, Mestriner LA, et al. Knee arthroplasty rating. J Arthroplasty, 1992, 7(2): 145-148.
14.	徐磊, 石興雷, 韓玉虎, 等. 單與雙鋼板內固定治療復雜脛骨平臺骨折比較. 中國矯形外科雜志, 2020, 28(12): 1081-1084.
15.	Krause M, Krüger S, Müller G, et al. How can the articular surface of the tibial plateau be best exposed? A comparison of specific surgical approaches. Arch Orthop Trauma Surg, 2019, 139(10): 1369-1377.
16.	Jansen H, Frey SP, Doht S, et al. Medium-term results after complex intra-articular fractures of the tibial plateau. J Orthop Sci, 2013, 18(4): 569-577.
17.	Evangelopoulos D, Chalikias S, Michalos M, et al. Medium-term results after surgical treatment of high-energy tibial plateau fractures. J Knee Surg, 2020, 33(4): 394-398.
18.	丁偉, 王小軍,封小東. 復雜脛骨平臺骨折雙切口雙鋼板內固定術的療效. 中華關節外科雜志 (電子版), 2020, 14(3): 320-323.
19.	Li DQ, Song DY, Ni JD, et al. A case report of Schatzker type Ⅵ tibial plateau fracture treated with double reverse traction closed reduction combined with minimally invasive percutaneous plate osteosynthesis technique: A case report. Medicine (Baltimore), 2017, 96(45): e8394. doi: 10.1097/MD.0000000000008394.
20.	翁能源, 張弢, 李開南, 等. 3D打印輔助治療SchatzkerⅣ-Ⅵ型脛骨平臺骨折療效及并發癥的薈萃分析. 中國組織工程研究, 2020, 24(30): 4889-4897.
21.	Ozturk AM, Suer O, Derin O, et al. Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures. Eur J Trauma Emerg Surg, 2020, 46(5): 1183-1194.
22.	夏冬瑞, 顏繼英, 張學斌. 脛骨平臺骨折術后膝關節僵硬的發生率及危險因素分析. 中國骨與關節損傷雜志, 2019, 34(12): 1315-1317.
23.	Li J, Zhang J, Zhao K, et al. Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults. J Orthop Surg Res, 2021, 16(1): 549. doi: 10.1186/s13018-021-02700-2.
24.	Christiano AV, Pean CA, Kugelman DN, et al. Function and knee range of motion plateau six months following lateral tibial plateau fractures. J Knee Surg, 2020, 33(5): 481-485.
25.	Gonzalez LJ, Hildebrandt K, Carlock K, et al. Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation. Bone Joint J, 2020, 102-B(5): 632-637.
26.	王焱新. 脛骨平臺骨折術后早期康復護理對膝關節功能康復的影響分析. 中國醫藥指南, 2020, 18(30): 220-221.
27.	Albtoush OM, Taib AA, Horger M, et al. Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation. Skeletal Radiol, 2018, 47(5): 699-702.
28.	Zaid M, Lansdown D, Su F, et al. Abnormal tibial position is correlated to early degenerative changes one year following ACL reconstruction. J Orthop Res, 2015, 33(7): 1079-1086.
29.	F?ndriks A, Tranberg R, Karlsson J, et al. Gait biomechanics in patients with intra-articular tibial plateau fractures-gait analysis at three months compared with age- and gender-matched healthy subjects. BMC Musculoskelet Disord, 2021, 22(1): 702. doi: 110.1186/s12891-021-04577-y.
30.	Li J, Zhu Y, Zhao K, et al. Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study. J Orthop Surg Res, 2020, 15(1): 349. doi:10.1186/s13018-020-01885-2.
31.	葛志強, 楊潔, 夏志勇, 等. 脛骨平臺骨折術后切口感染發生率及危險因素分析. 中國骨與關節損傷雜志, 2020, 35(4): 417-419.
32.	Henkelmann R, Glaab R, Mende M, et al. Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study. BMC Musculoskelet Disord, 2021, 22(1): 531. doi: 10.1186/s12891-021-04402-6.

1. 朱燕賓, 侯志勇, 金柱成, 等. 2010年至2011年華北五省市18所醫院脛骨平臺骨折流行病學調查研究. 中華創傷骨科雜志, 2020, 22(8): 682-686.
2. Aurich M, Koenig V, Hofmann G. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review. Asian J Surg, 2018, 41(2): 99-105.
3. Toor AS, Limpisvasti O, Ihn HE, et al. The significant effect of the medial hamstrings on dynamic knee stability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2608-2616.
4. Curtis BR, Huang BK, Pathria MN, et al. Pes Anserinus: Anatomy and pathology of native and harvested tendons. AJR Am J Roentgenol, 2019, 213(5): 1107-1116.
5. 劉超, 王鐵軍, 寧漱巖, 等. 老年脛骨平臺骨折術后并發癥和手術入路研究進展. 中國老年學雜志, 2018, 38(2): 507-509.
6. 袁亮, 呂揚, 周方. 脛骨平臺骨折患者術后生活質量的研究現狀. 中國組織工程研究, 2018, 22(19): 3097-3102.
7. Yan B, Sun J, Yin W. The prevalence of soft tissue injuries in operative Schatzker type Ⅳ tibial plateau fractures. Arch Orthop Trauma Surg, 2021, 141(8): 1269-1275.
8. Adams JDJ, Loeffler MF. Soft tissue injury considerations in the treatment of tibial plateau fractures. Orthop Clin North Am, 2020, 51(4): 471-479.
9. 馬凱. 內側入路治療脛骨平臺骨折時對鵝足不同處理方法的預后分析. 石家莊: 河北醫科大學, 2015.
10. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res, 1979, (138): 94-104.
11. 湯旭日, 王秋根, 張秋林, 等. 脛骨平臺骨折術后高度丟失的原因及對策. 中華創傷骨科雜志, 2004, 6(3): 24-27.
12. Beisemann N, Vetter SY, Keil H, et al. Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study. Orthop Traumatol Surg Res, 2021. doi: 10.1016/j.otsr.2021.102922.
13. Binazzi R, Soudry M, Mestriner LA, et al. Knee arthroplasty rating. J Arthroplasty, 1992, 7(2): 145-148.
14. 徐磊, 石興雷, 韓玉虎, 等. 單與雙鋼板內固定治療復雜脛骨平臺骨折比較. 中國矯形外科雜志, 2020, 28(12): 1081-1084.
15. Krause M, Krüger S, Müller G, et al. How can the articular surface of the tibial plateau be best exposed? A comparison of specific surgical approaches. Arch Orthop Trauma Surg, 2019, 139(10): 1369-1377.
16. Jansen H, Frey SP, Doht S, et al. Medium-term results after complex intra-articular fractures of the tibial plateau. J Orthop Sci, 2013, 18(4): 569-577.
17. Evangelopoulos D, Chalikias S, Michalos M, et al. Medium-term results after surgical treatment of high-energy tibial plateau fractures. J Knee Surg, 2020, 33(4): 394-398.
18. 丁偉, 王小軍,封小東. 復雜脛骨平臺骨折雙切口雙鋼板內固定術的療效. 中華關節外科雜志 (電子版), 2020, 14(3): 320-323.
19. Li DQ, Song DY, Ni JD, et al. A case report of Schatzker type Ⅵ tibial plateau fracture treated with double reverse traction closed reduction combined with minimally invasive percutaneous plate osteosynthesis technique: A case report. Medicine (Baltimore), 2017, 96(45): e8394. doi: 10.1097/MD.0000000000008394.
20. 翁能源, 張弢, 李開南, 等. 3D打印輔助治療SchatzkerⅣ-Ⅵ型脛骨平臺骨折療效及并發癥的薈萃分析. 中國組織工程研究, 2020, 24(30): 4889-4897.
21. Ozturk AM, Suer O, Derin O, et al. Surgical advantages of using 3D patient-specific models in high-energy tibial plateau fractures. Eur J Trauma Emerg Surg, 2020, 46(5): 1183-1194.
22. 夏冬瑞, 顏繼英, 張學斌. 脛骨平臺骨折術后膝關節僵硬的發生率及危險因素分析. 中國骨與關節損傷雜志, 2019, 34(12): 1315-1317.
23. Li J, Zhang J, Zhao K, et al. Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults. J Orthop Surg Res, 2021, 16(1): 549. doi: 10.1186/s13018-021-02700-2.
24. Christiano AV, Pean CA, Kugelman DN, et al. Function and knee range of motion plateau six months following lateral tibial plateau fractures. J Knee Surg, 2020, 33(5): 481-485.
25. Gonzalez LJ, Hildebrandt K, Carlock K, et al. Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation. Bone Joint J, 2020, 102-B(5): 632-637.
26. 王焱新. 脛骨平臺骨折術后早期康復護理對膝關節功能康復的影響分析. 中國醫藥指南, 2020, 18(30): 220-221.
27. Albtoush OM, Taib AA, Horger M, et al. Avulsion fracture of an ossified pes anserinus tendon post-lateral patellar dislocation. Skeletal Radiol, 2018, 47(5): 699-702.
28. Zaid M, Lansdown D, Su F, et al. Abnormal tibial position is correlated to early degenerative changes one year following ACL reconstruction. J Orthop Res, 2015, 33(7): 1079-1086.
29. F?ndriks A, Tranberg R, Karlsson J, et al. Gait biomechanics in patients with intra-articular tibial plateau fractures-gait analysis at three months compared with age- and gender-matched healthy subjects. BMC Musculoskelet Disord, 2021, 22(1): 702. doi: 110.1186/s12891-021-04577-y.
30. Li J, Zhu Y, Zhao K, et al. Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study. J Orthop Surg Res, 2020, 15(1): 349. doi:10.1186/s13018-020-01885-2.
31. 葛志強, 楊潔, 夏志勇, 等. 脛骨平臺骨折術后切口感染發生率及危險因素分析. 中國骨與關節損傷雜志, 2020, 35(4): 417-419.
32. Henkelmann R, Glaab R, Mende M, et al. Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study. BMC Musculoskelet Disord, 2021, 22(1): 531. doi: 10.1186/s12891-021-04402-6.

Chinese Journal of Reparative and Reconstructive Surgery

Open reduction and internal fixation with plate via posteromedial approach of retaining pes anserinus tendon in the treatment of tibial plateau fracture

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