Arthroscope-assisted minimally invasive percutaneous plate osteosynthesis in treatment of tibial plateau fractures

doi:10.3877/ cma.j.issn.1674-134X.2025.01.008

Abstract

Abstract:

Objective

To explore the effect of arthroscope-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of SchatzkertypeⅡ-Ⅳof tibial plateau fractures.

Methods

From March 2021 to March 2024, 135 patients who were diagnosed with tibial plateau fractures and no open fractures and were able to tolerate surgery and anesthesia in department of orthopaedics of the First Affiliated Hospital of the PLA Air Force Military Medical University were selected and divided into traditional surgery group (traditional incision internal fixation, 64 cases) and minimally invasive surgery group (knee arthroscopy-guided MIPPO technique reduction internal fixation,71 cases) by means of different treatment methods.The efficacy of the two groups was compared by rank sum test.The normal measurement data such as pain stress indicators ［substance P (SP), neuropeptide Y (NPY) and prostaglandin E₂ (PGE₂)］ and functional recovery (walking frequency, walking speed and walking amplitude) were measured by t test.Enumeration data such as occurrence of complications were detected by chi square test.

Results

The excellent and good rate of treatment in minimally invasive surgery group was 92.8%, which was higher than 82.9% in traditional surgery group (χ²=6.084, P<0.05).At 10 days after surgery, the levels of SP, NPY and PGE₂ in the two groups were reduced (traditional surgery group t=9.106, 32.697, 18.370, minimally invasive surgery group t=14.371, 45.266, 25.712, all P<0.05), and the levels in minimally invasive surgery group were lower than those in traditional surgery group (t=9.120, 11.640,9.336, all P<0.05).At six months after surgery, the walking frequency, walking speed and walking amplitude were higher in minimally invasive surgery group than in traditional surgery group (t=3.674, 3.275, 3.273, all P<0.05).The incidence of surgical complications in minimally invasive surgery group with 3.2% was lower than 15.6% in traditional surgery group (χ²=5.026, P<0.05).

Conclusions

Knee arthroscopy-guided MIPPO technique reduction internal fixation has significant efficacy in the treatment of tibial plateau fractures.It can significantly improve the pain stress response, promote the recovery of joint function, and reduce the incidence of complications.

Key words: Arthroscope, Minimally invasive surgical procedure, Internal fixators, Tibial plateau fractures, Pain, Functional recovery

Ming Luo, Zhi Yuan, Junjun Fan, Binghui Liao, Haifeng Dang, Tianlei Zheng, Lingxin Bai. Arthroscope-assisted minimally invasive percutaneous plate osteosynthesis in treatment of tibial plateau fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 46-54.

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Figures/Tables 7

Table 1 Comparison of baseline data between the two groups of patients

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	性别（男/女）Gender (male/female)	损伤类型（例）Injury type
组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	性别（男/女）Gender (male/female)	跌伤Falling injury	车祸Car accident	运动损伤Sports injury
传统手术组Traditional surgery group	64	52. 1±5. 9	36/28	29	18	17
微创手术组Minimally invasive surgery group	71	52. 7±5. 2	39/32	36	19	16
统计值Statistical values		t=0. 629	χ ²=0. 024		χ ²=0. 449
P值		>0. 05	>0. 05		>0. 05
组别Groups	例数Number of cases	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ±s）］Body mass index	骨折部位（左/右）Fracture site (left/right)	Schatzker骨折分型（例）Schatzker fracture typing
组别Groups	例数Number of cases	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ±s）］Body mass index	骨折部位（左/右）Fracture site (left/right)	Ⅱ	Ⅲ	Ⅳ
传统手术组Traditional surgery group	64	23. 6±2. 6	37/27	21	32	11
微创手术组Minimally invasive surgery group	71	23. 3±12. 7	45/26	24	35	15
统计值Statistical values		t=0. 203	χ ²=0. 438		χ ²=0. 108
P值		>0. 05	>0. 05		>0. 05

Table 1 Comparison of baseline data between the two groups of patients

组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	性别（男/女）Gender (male/female)	损伤类型（例）Injury type
组别Groups	例数Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］Age (year)	性别（男/女）Gender (male/female)	跌伤Falling injury	车祸Car accident	运动损伤Sports injury
传统手术组Traditional surgery group	64	52. 1±5. 9	36/28	29	18	17
微创手术组Minimally invasive surgery group	71	52. 7±5. 2	39/32	36	19	16
统计值Statistical values		t=0. 629	χ ²=0. 024		χ ²=0. 449
P值		>0. 05	>0. 05		>0. 05
组别Groups	例数Number of cases	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ±s）］Body mass index	骨折部位（左/右）Fracture site (left/right)	Schatzker骨折分型（例）Schatzker fracture typing
组别Groups	例数Number of cases	身体质量指数［kg/m²，（ $\overset{ˉ}{x}$ ±s）］Body mass index	骨折部位（左/右）Fracture site (left/right)	Ⅱ	Ⅲ	Ⅳ
传统手术组Traditional surgery group	64	23. 6±2. 6	37/27	21	32	11
微创手术组Minimally invasive surgery group	71	23. 3±12. 7	45/26	24	35	15
统计值Statistical values		t=0. 203	χ ²=0. 438		χ ²=0. 108
P值		>0. 05	>0. 05		>0. 05

Table 2 Comparison of efficacy between the two groups (n, %)

组别Groups	例数Number of cases	优Excellent	良Good	可Fair	差Poor	优良率Excellent and good rate
传统手术组Traditional surgery group	64	26（40. 6）	27（42. 2）	7（10. 9）	4（6. 3）	53（82. 9）
微创手术组Minimally invasive surgery group	71	43（60. 6）	25（35. 2）	2（2. 8）	1（1. 4）	68（92. 8）
统计值Statistical values			U=2. 695			χ ²=6. 084
P值			0. 007			0. 014

Table 3 Comparison of pain stress indicators between the two groups

组别Groups	例数Number of cases	SP（pmol/L）		NPY（ng/L）		PGE₂（ng/L）
组别Groups	例数Number of cases	术前Beforesurgery	术后10 d10 daysafter surgery	术前Beforesurgery	术后10 d10 daysafter surgery	术前Beforesurgery	术后10 d10 daysafter surgery
传统手术组Traditional surgery group	64	9. 1±2. 3	6. 2±1. 1^*	182. 6±7. 9	128. 5±10. 6^*	158. 6±17. 5	113. 6±8. 7^*
微创手术组Minimally invasive surgery group	71	9. 1±2. 3	4. 6±0. 9^*	183. 2±7. 5	106. 5±11. 3^*	159. 3±16. 1	98. 6±9. 8^*
t 值		0. 025	9. 120	0. 407	11. 640	0. 231	9. 336
P值		>0. 05	＜0. 001	>0. 05	＜0. 001	>0. 05	＜0. 001

Table 4 Comparison of functional recovery status between the two groups

组别Groups	例数Number of cases	步行频率（步/min）Walking frequency (step/min)	步行速度（cm/s）Walking speed	步行幅度（cm）Walking amplitude
传统手术组Traditional surgery group	64	57±4	86±5	52±5
微创手术组Minimally invasive surgery group	71	59±4	90±6	55±5
χ ² 值		3. 674	3. 275	3. 273
P值		＜0. 001	0. 001	0. 001

Table 5 Comparison of occurrence of complications between the two groups ［n (%)］

组别Groups	例数Number of cases	局部感染Local infection	皮肤坏死Skin necrosis	骨折延迟愈合Delayed healing	关节炎Arthritis	畸形愈合Deformity healing	总发生率Total incidence rate
传统手术组Traditional surgery group	64	3（4. 7）	2（3. 1）	3（4. 7）	1（1. 6）	1（1. 6）	10（15. 6）
微创手术组Minimally invasive surgery group	71	1（1. 4）	1（1. 4）	1（1. 4）	0	0	3（3. 2）
χ ² 值							5. 026
P值							0. 025

Figure 1 Images of the left knee joint of the first typical case before and after surgery.A is preoperative X-ray image at anteroposterior view of left knee, B to D are preoperative CT images of the left knee, showing that the lateral tibial plateau fracture of the left knee, and the collapse was obvious; E is visial field of arthroscope during the operation, showing the splitting and collapse of the lateral tibial plateau,obvious fracture displacement, uneven articular surface and partial meniscus injury; F is arthroscopic image of reduction of fracture under arthroscope combined with percutaneous minimally invasive plate internal fixation, showing that the articular surface was restored and the fracture was anatomically reduced during the surgery; G and H are the X-ray images at anteroposterior and lateral views of the left knee joint on the second day after surgery, showing that the fracture position was good and the internal fixation was normal; I and J are the X-ray images at anteroposterior and lateral views of the left knee joint three months after the surgery, showing that the fracture position healed well and the internal fixation was well in position

Figure 2 Images of left knee joint of the second typical case before and after surgery.A is anteroposterior and lateral views of left knee in preoperative X-ray, B and C are preoerative CT and three dimensional reconstruction images, showing that the lateral tibial plateau fracture with significant collapse; D is intraoperative X ray image at anteroposterior and lateral view of left knee, showing the position of plates; E is the surgical incision of MIPPO(percutaneous minimally invasive plate internal fixation); F is visual field under arthroscope, showing the collapse of the lateral tibial plateau with obvious fracture displacement, and step-like unevenness of the articular surface; G is image during the arthroscope combined with MIPPO, showing that the anatomical reduction of bone fracture and the articular surface was restored; H is the X-ray image at anteroposterior and lateral views of the left knee joint and I is the three-dimensional reconstruction CT images on the second day after surgery, both showing that the fracture position was good and the internal fixation was normal；J is X-ray image of the left knee joint three months after surgery, showing good fracture healing and no abnormality in internal fixation

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