Efficacy and safety of posterolateral knee inverted“L”shaped pathway when placing the supporting plate / 中国组织工程研究

ABSTRACT

BACKGROUND:Studies have shown that tibial plateau posterolateral fractures can be treated by posterolateral knee approach, however, there is no clear anatomical research to deeply evaluate and analyze this approach. OBJECTIVE:To evaluate the efficacy and safety of posterolateral knee inverted“L”shaped pathway in invloving tibial plateau posterolateral fractures. METHODS:Eight fresh frozen adult corpses, 16 knees side, were al dissected using posterolateral inverted“L”shaped pathway. During the dissection, the exposure range was observed and important parameters of anatomical structure were measured. RESULTS AND CONCLUSION:The pathway may be ful y exposed to the posterolateral aspect of tibial plateau and posterior cruciate ligament tibial insertions. The operations completed by out team did not create any obvious interference to superior tibiofibular joint, fibular head and posterolateral corner structure. The exposed mean length of common peroneal nerve in incision was 56.48 mm, with a mean angle of 14.7° tilt towards the axis of the fibula. The mean distance between the neck of the fibular and fibular head tip was 31.26 mm, an average of 42.18 mm to the joint line. The mean distance between the opening of the interosseous membrane and the articular surface was 48.78 mm. The divergence of the fibular artery from the posterior tibial artery was an average of 76.46 mm from articular surface. These results confirm that posterolateral inverted“L”shaped pathway met the requirements of anatomical reduction and buttress fixation for posterolateral tibial plateau fracture. Exposure of the common peroneal nerve can be minimized or even avoided by modifying the skin incision. Because the popliteal artery branches anterior tibial artery passed through interosseous membrane hole and peroneal artery and then separated from the posterior tibial artery, pathways dissection to distal deep area should be carried out careful y. Placement of a posterior buttressing plate carries a high vascular risk if the plate is implanted beneath these vessels.