The Design Of Guided Reduction And Bone-grafting Instrument And Its Application Research In Tibial Plateau Fractures

Objective:About Tibial plateau compressed fracture, the early experience is that if the platform does not compress more than 10 millimeters,we do not reduct it and select conservative treatment, but recent studies have confirmed rough articular surface is a direct result of the formation of articular cartilage degeneration and accelerate the process of osteoarthritis. The anatomic reduction, bone graft and solid fixation are necessary condition for a good reveal. Commonly used approach to the treatment of compressed fracture is small windows below platform, bone knife or curet poking reset, bone graft under the fractures surface. However, because there is no special tools and sophisticated fixed operational procedures, lack of standardized operation and accuracy, so long-term follow-up also found that defects of such treatment: Lit is difficult to achieve anatomic reduction of articular surface fractures; 2. reduction operation itself may result in under-articular cancellous bone damage and further leads to the loss of bone mass; 3.it can not accurately measure the volume of bone missing volume; 4.it can not accurately and adequately cut the bone and bone graft, nor the appropriate means of evaluation of bone quality; 5. it is difficult to avoid articular surface recompression; 6.particle bone grafting makes fracture fixation difficult and thus increases the soft tissue injury, and influences bone and soft tissue wound healing, and increases joint dysfunction; 7. the platform window under the fracture surface undermined the proximal tibial bone support structure and soft tissue fixed and nutritional support.This study attempts to exert arthroscopy with the C-arm X-ray machine, at the same time with the advantages of minimally invasive treatment, using guided reduction and bone-grafting instrument ,makes it easy and precise to bone graft and fixation of tibial plateau fracture ,address the shortcomings of traditional surgical procedures to reduce surgical complications and shorten the recovery time of patients hospitalization, saving hospitalization costs, saving the community health resources, as well as opening up a new way for other parts of the intra-articular fractures.Methods:1. special instrument design:1)-oriented trepan, 11 millimeters diameter 10 cm long hollow trepan axial end of welding 3 mm diameter hollow extension rod Trigonobalanus easy to connect power tools, assisted tibial plateau under the window; 2) oriented impactor, outside diameter 10 mm length 10 cm into the solid blunt rod drilling a 3 mm diameter hollow shaft.2. clinical cases of Application ResearchIn accordance with 40 cases for sub-type selection Schazkerâ…¡,â…¢-type tibial plateau fracture, arthroscopic reduction and bone graft treatment group was the treatment group, open reduction and internal fixation group was the control group, stratified random allocation of patients to the group. Conventional examinations are X film, CT and three-dimensional reconstruction, MRI,and if necessary, angiography. Mean operative time was 4 days away from the injury time.3. Treatment methodsArthroscopic surgery : combined spinal-epidural anesthesia , tourniquet at the root of thigh knee ,natural sag in the edge, connect and test Preoperative radiographic C-arm X-ray machine, anterior medial and anterolateral arthroscopic approach enter and equipment, water does not rely on intra-articular infusion pumps butis injected by gravity.First intra-articular blood drainage, remove blood clots and intra-articular debris, inspect patellar pouch, patellofemoral joint, medial and lateral gap between the concave condyle, the medial gap, the lateral gap. According to intraoperative observation of the situation we decided of further surgical steps. If cruciate ligament injuries do not interfere with observation of the operation ,we need no treatment. Generally deal with meniscus injury after fracture repair or angioplasty. under Arthroscopy, determine the focal point of fracture according to ACL locator , under the platform at the medial tibial tubercle 2 cm into a 1-mm Kirschner wire needle to do guided to the hollow-driven trephine tibial cortex fenestration, enter the hollow device, respectively, under the supervision of arthroscopy and the C-arm X-ray machines, lift the articular surface of cartilage, intra-articular auxiliary equipment manually reset articular surface fractures, and maintain articular surface of cartilage formation and higher than the normal articular noodle about 2 millimeters. Use Kirschner wire through the lateral articular surface fracture for a temporary fixed block, using oriented trephine cut and trim shape suitable autogenous iliac or hollow self-setting calcium phosphate cement in the bone graft inside the tunnel, filling closed medullary cavity with tibial cortical bone, screwed into the hollow pressurized titanium cancellous bone screw horizontalto platform for fixation.Open reduction and internal fixation group: combined spinal-epidural anesthesia, supine position, conventional disinfection, tourniquet for the blood drive, check anterior lateral incision about 5cm - 10cm, along the lower edge of the meniscus joint capsule incision, exposed articular surface. knife or bone saw rings windows under Platform, articular surface reduction with the periosteal stripping and bone rods, temporary Kirschner wire fixation, if the reduction is good under C-arm fiuoroscopy ,we make Kirschner pin screw or plate fixation.Observation and method : data collection, recording, preservation and analysis are in charge of trained personnel, in accordance with the principle of double-blind, surgeon is not involved in this work. Observation of the project includs operation time, X-ray projection frequency, length of stay in hospital, knee function score after 3 months, 6 months, 12 months.Resultsthe above results (operative time, intraoperative X-ray projection frequency, knee function score after 3 months, 6 months, 12 months ) have statistical significance difference (P <0.05)beteen two groups, the treatment group is better than that of the control group, also in the postoperative early stage.Conclusion1. Treatment for Schazkerâ…¡,â…¢-type tibial plateau fractures under arthroscopy and X-ray machine-assisted reduction and oriented, compared with traditional open reduction techniques, has shorter surgerytime ,shorter hospitalization time, fewer intraoperative perspective, and better postoperative efficacy.2.guided reduction and bone-grafting technology is more accurate and convenient, the grafting operation under Platform can be accurately targeted and quantitative.3. tibial plateau compressed fractures, lateral collapse, the medial bone graft fenestration reset can accurately evaluate the amount of bone defects, providing an effective support to platform.4. problem of leakage in arthroscopy-assisted treatment of tibial plateau fractures can be solved by low-pressure high-flow perfusion solution.