No abstract

Данные о локализации и видах переломов области коленного сустава недостаточны. Цель исследования: получение сведений о локализации и характере переломов дистального отдела бедренной и проксимального отдела большеберцовой кости, а также использованных методах их лечения на основании анализа статистической отчетности городского стационара и первичной медицинской документации. Проанализировано 758 выбывших из стационара пациентов с кодами МКБ: S82.1, S82.7, S82.8, S72.4, S72.7, S72.8 в период 2015-2017 гг. По архивным рентгенограммам им был поставлен диагноз по классификации АО. Соответствие локализаций переломов по изучаемым классификациям зафиксировано в 210 случаях: у 173 пациентов с переломами проксимального метаэпифиза большеберцовой кости (ПМББК) и 37 пациентов с переломами дистального метаэпифиза бедренной кости (ДМБК). Изучены виды применённого им лечения и характер выполненных операций остеосинтеза. Из 37 больных с переломами ДМБК прооперирован 21 больной (56,8%), среди 173 больных с переломами ПМББК-89 больных (51,4%). При переломах ДМБК из 65 больных, кодированных по МКБ, 37 (57%) соответствуют переломам дистального сегмента бедренной кости по классификации АО (Типы 33 А, В, С). Наибольшее количество этих пациентов (35 больных, 94,6%) приходится на код МКБ S 72.4. При переломах ПМББК из 693 больных, кодированных по МКБ, 173 (25%) соответствуют переломам проксимального сегмента большеберцовой кости по классификации АО (Типы 41 А, В, С). Из 207 больных с кодом МКБ S 82.1 173 (83,6%) соответствуют переломам проксимального сегмента большеберцовой кости по классификации АО (Типы 41 А, В, С). Таким образом, наряду с кодированием диагноза по МКБ, целесообразно применение классификации АО как наиболее полно отражающей характер перелома и позволяющей планировать варианты оперативного лечения. Ключевые слова: перелом дистального отдела бедренной кости, перелом плато большеберцовой кости, классификация АО, МКБ-10.

Purpose of the study — to provide an anatomical rationale and evaluate the clinical application of posterolateral surgical approach with osteotomy of the fibular head for internal fixation of the posterior aspect of the lateral tibial condyle. Material and Methods. Anatomical topography research was performed on 14 lower limbs of 8 fresh cadavers. In the first series of research L-shaped plate was fixed on the posterolateral surface of lateral tibial condyle from the examined approach, then preparation was performed and measuring of distances from various parts of the plates to the common peroneal nerve and anterior tibial artery. In the second series the authors prepared histological topograms by transverse sectioning of plastinated specimens from the knee joint area after implantation of L-shaped buttress plates. Prospective observation clinical study included 20 patients who underwent internal fixation with L-shaped buttress plate from the examined approach for fracture of the posterolateral column of the tibial plateau, type 41В by AO classification. KSS and Lysholm scales were used to evaluate treatment outcomes at days 7–10 and in 1, 3, 6 and 9 months postoperatively. Data of the anatomical and clinical research was compared. Results. Compliance with the technique of posterolateral transfibular surgical approach allows to avoid risk of injury to the common peroneal nerve and anterior tibial arthery which on the specimen were always located safely away from implanted plates. All 20 clinical cases demonstrated good visualization of bone fragments and articular surface of the tibial plateau which ensured reliable reduction and fixation by L-shaped buttress plate. KSS excellent and good outcome scores amounted to 50% and 45%, respectively, while satisfactory score was reported in 5% of cases; Lysholm scale demonstrated 55% of excellent outcomes, 45% of good outcomes, and 5% of satisfactory outcomes. Safety of the approach was verified: no injuries to large blood vessels or iatrogenic neuropathies were reported as well as no large hematomas or infectious complications of the surgical wound in early postoperative period. Conclusion. Results of the present study proved the feasibility and safety of the posterolateral transfibular surgical approach for internal fixation procedures in patients with intraarticular fractures of posterolateral column of the tibial plateau.

Intention. To conduct a comparative analysis of the dynamics of the consolidation of intraarticular fractures of the posterolateral parts of the lateral tibial condyle, the anatomical and functional outcomes of surgical treatment of these patients after plate osteosynthesis with traditional anterolateral and posterolateral transfibular surgical approaches as well.Methodology. A comparative prospective study of the effectiveness of osteosynthesis in patients with fractures of the posterolateral part of lateral tibial condyle in two compatible clinical groups was performed in dynamics for periods of 7–10 days, 1, 3, 6 and 9 months after surgery. In the first group (25 patients), bone osteosynthesis was performed from traditional anterolateral approach (TALA), and in the second group (20 patients), from the posterolateral transfibular approach (PLTFA). The average duration of osteosynthesis operations was compared. The displacements of fragments of the articular surface of the lateral tibial condyle, the indices of the KSS and Lysholm scales, the results of measurements of the angle of flexion and valgus stress test of the knee joint were evaluated. Data processing was performed using the Data Analysis and Chart Master modules (Excel), the Basic Statistics / Tables module (Statistic for Windows) as well.Results and Discussion. In the PLTFA group, the average operation time was (81.0 ± 8.5) minutes (from 67 to 96 minutes), in the TALA group, the duration of operations was 35.8 % longer and averaged (110 ± 5.2) minutes (from 82 to 125 minutes) (p < 0.05). The values of the KSS and Lysholm scales in dynamics showed a steady and statistically significant (p < 0.01) increase with increasing time after surgery without significant differences between the groups. The angle of flexion of the knee joint increased more rapidly during the first three months, then the rate decreased from 6 to 9 months (p < 0.05) without significant differences between the groups. The frequency of displacements of fragments of the articular surface in the first group was statistically significantly (p < 0.05) higher than in the second group. Differences in the valgus-stress test indices in both groups reached a maximum after 9 months – 52 and 30 %, respectively.Conclusion. With PLTFA, surgery duration decreases, articular surface fragments are better reduced, and their subsequent displacement at the stages of treatment is less likely; therefore, this approach is preferable for osteosynthesis of fractures of the posterolateral parts of the lateral tibial condyle.