Clinical Study Of Kirschner Wire In The Treatment Of Posterolateral Collapsed Fracture Of Tibial Plateau

Objective: Kirschner wire assisted support and steel plate fixation were used to treat PCF-TP.The clinical efficacy of simple steel plate fixation in the treatment of PCFTP was compared,and the surgical points and clinical value of Kirschner wire assisted support in the treatment of PCF-TP were discussed.Methods: According to the standard of diagnosis and treatment of tibial plateau fracture,all patients were examined by X-ray and CT,and the exclusion and inclusion criteria of PCF-TP patients in this study were established.Patients with PCF-TP articular surface collapse larger than 3mm were included in this study.Detailed physical examination was performed before operation to further determine whether PCF-TP was associated with nerve and vascular tissue injury.1.Grouping: According to the exclusion and inclusion criteria of patients with PCFTP in this study,42 patients with PCF-TP diagnosed in the Department of Orthopaedic Trauma,Chifeng Municipal Hospital of Inner Mongolia Medical University from September 01,2019 to December 31,2021 were divided into two groups: Kirschner wire plus plate fixation group(group A)and simple plate fixation control group(group B).2.Surgical methods: All the 42 patients were treated with posterolateral tibial plateau approach and completed by the same group of surgeons in the contralateral recumbent position.The same type of surgical instruments and steel plates were used during the operation.Group A surgical methods: The PCF-TP was exposed by the posterolateral approach of the tibial plateau,the articular surface fracture was observed by C-type X-ray machine,the collapsed fracture was reduced,the subchondral bone plate was fixed with 1.5mm or 2.0mm Kirschner wire according to the size of the fracture,and the PCF-TP was fixed from the anterior skin of the tibia to avoid the peripheral nerves and blood vessels of the knee joint.Based on Kirschner wire-assisted fixation,the PCF-TP was fixed with 3.5 series "T" plate,and the leakage part of the retained Kirschner wire was cut short and bent into an "L" shape after gauze winding to prevent the Kirschner wire from being embedded in the nerves and blood vessels on the back of the knee joint after skin injury and close the incision.Group B surgical methods: The PCF-TP was exposed by the posterolateral approach of the tibial plateau,the collapsed fracture piece of the posterolateral tibial plateau was reduced,and the subchondral bone plate was penetrated the posterior front of the tibial plateau to temporarily fix the articular surface.The anatomical reduction of articular surface fracture was observed by C-type X-ray machine.Materials such as autogenous iliac bone or artificial bone were transplanted into the bone defect under the tibial plateau,and then 3.5 series "T" plates were shaped,attached to the posterolateral side of the tibial plateau and fixed with screws.The temporary fixed Kirschner wire is removed after the steel plate is fixed and the incision is closed.3.Postoperative treatment: The two groups of patients strictly prevent deep venous thrombosis of lower extremities during postoperative hospitalization,and provide professional guidance to patients,including related functional exercise and psychological counseling,until the fracture healed.4.Clinical data collection: The relevant clinical data during and after operation in both groups need to be recorded and collected.Including the date and time of operation,the amount of intraoperative blood loss and postoperative blood loss,the HSS score and Rasmussen score of knee joint 3 days and 12 months after operation,and the measurement data of range of motion(Range Of Motion,ROM),varus angle(Total Kee Arthroplasty,TKA),posterior inclination angle(Posterior Tibial Slope,PTS)and thigh-tibial angle(Femorotibial Angle,FTA)of the affected limb.5.Statistical analysis: According to the characteristics of the collected clinical data,uniform distribution and homogeneity of variance test were carried out,and the significant difference of clinical efficacy between group An and group B was analyzed,and the clinical efficacy of Kirschner needle plus plate fixation and simple plate fixation in the treatment of PCF-TP was compared.Results:In group A,PCF-TP was fixed with Kirschner wire and pure steel plate during and after operation,and complete follow-up data were obtained.In group B,PCF-TP was fixed with simple steel plate after operation,and complete follow-up data were collected.There was no significant difference in operation time,intraoperative blood loss,incision length,postoperative blood loss,knee joint score(including Rasmussen score,HSS score)and ROM,tibial plateau TKA,PTS and FTA data between the two groups.There were significant differences in knee joint score,ROM,tibial plateau TKA,PTS and FTA between the two groups at 12 months after operation.In group A,the Kirschner wire was close to the subchondral bone plate of the tibial plateau under direct vision,and the anatomical reduction of PCF-TP was completed in the limited operating space.Compared with group B,the degree of postoperative collapse of the posterolateral articular surface of tibial plateau in group A was lower or there was no collapse,the function of knee joint in group A was better than that in group B,and there was no infection.Conclusion: Kirschner wire assisted support treatment of PCF-TP,in the same treatment period without increasing the difficulty of operation and tissue injury,through the subchondral plate elastic fixation to make the cartilage surface more stable,the fixation effect is reliable to avoid postoperative collapse,which is a desirable method for the treatment of PCF-TP.