Супрапателлярный остеосинтез при переломах проксимального отдела голени

А. А. Ситник, А. Г. Герасимов, С. А. Попок, В. А. Врублевский, О. А. Корзун, П. А. Волотовский, М. А. Герасименко Республиканский научнопрактический центр травматологии и ортопедии, Минск, Городской клинический центр травматологии и ортопедии, Минск, УЗ «11 ГКБ», Минск

2021 №3 | Лекции

Аннотация

Список литературы

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Лечение внесуставных переломов проксимального отдела большеберцовой кости характеризуется сложностями репозиции, а также высокой частотой осложнений изза типичных повреждений мягких тканей. В статье представлен аналитический обзор данных о применении супрапателлярного доступа для интрамедуллярного остеосинтеза внесуставных переломов проксимального отдела большеберцовой кости. Описана техника выполнения хирургического вмешательства и основные методы репозиции переломов указанной локализации. Имеющиеся на сегодняшний день данные позволяют полагать, что применение супрапателлярного остеосинтеза большеберцовой кости при должном соблюдении хирургической техники не вызывает значимых негативных эффектов на коленный сустав. При супрапателлярной установке интрамедуллярного стержня значительно облегчается репозиция и интраоперационный контроль положения отломков при переломах проксимального отдела голени, однако при необходимости следует использовать дополнительные средства репозиции.

Ключевые слова:

большеберцовая кость, перелом, проксимальный отдел, интрамедуллярный остеосинез, супрапателлярный доступ

Suprapateller nailing in proximal tibia fractures

The treatment of extraarticular proximal tibia fractures is characterized by the difficulties in obtaining the proper reduction and high rate of complications due to the typical softtissue injuries. The literature data on the use of suprapatellar approach for intramedullary nailing of exraarticuar fractures of the proximal tibia are analyzed in the article with special attention to the surgical technique of fracture reduction and nail application. Current data shows that the suprapatellar approach is safe when performed properly and has no adverse influence on the knee joint. The reduction of the fracture and intraoperative radiologic control are simplified by this technique, but additional reduction tools shall be available.

Keywords

tibia – fracture – proximal – intramedullary fixation – suprapatellar approach

Литература
1. Bono, C. M., Levine R. G., Rao J. P., Behrens F. F. Nonarticular proximal tibia fractures: treatment options and decision making // J Am Acad Orthop Surg. – 2001. – № 9. – Р. 176–86.
2. Court-Brown, C. M., McBirnie J. The epidemiology of tibial fractures // J Bone Joint Surg Br. – 1995. – Vol. 77. – P. 417–21.
3. Hernigou, P., Cohen D. Proximal entry for intramedullary nailing oft he tibia. The risk of unrecognized articular damage // J Bone Joint Surg Br. – 2000. – Vol. 82. – P. 33–41.
4. Oh, J. K., Sahu D., Hwang J. H., Cho J. W., Oh C. W. Technical pitfall while reducing the mismatch between LCP PLT and upper end tibia in proximal tibia fractures // Arch Orthop Trauma Surg. – 2010. – Vol. 130. – Р. 759–63.
5. Bhandari, M, Audige L., Ellis T., Hanson B. Evidence-Based Orthopaedic Trauma Working Group. Operative treatment of extra-articular proximal tibial fractures // J Orthop Trauma. – 2003. – Vol. 17. – P. 591–5.
6. Kurylo, J. C., Tornetta P. Extra-articular proximal tibial fractures: Nail or plate // AAOS Instructional Course Lectures. – 2013. – Vol. 62. – P. 61–77.
7. Lindvall, E., Sanders R., DiPasquale T., Herscovici D., Haidukewych G., Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: Comparison of 56 cases // J Orthop Trauma. – 2009. – Vol. 23. – P. 485–92.
8. Naik, M. A., Arora G., Tripathy S. K., Sujir P., Rao S. K. Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: A prospective study // Injury. – 2013. – Vol. 44. – P. 1081–6.
9. Attal, R., Hansen M., Kirjavainen M., Bail H., Hammer O., Rosenberger R. et al. A multicenter case series of tibia fractures treated with the Expert Tibia Nail (ETN) // Arch Orthop Trauma Surg. – 2012. – Vol. 132. – P. 975–84.
10. Cannada, L. K., Anglen J. O., Archdeacon M. T., Herscovici Jr. D., Ostrum R. F. Avoiding complications in the care of fractures of the tibia // J Bone Joint Surg Am. – 2008. – Vol. 90. – P. 1760–8.
11. Hansen, M., Mehler D., Hessmann M. H., Blum J., Rommens P. M. Intramedullary stabilization of extraarticular proximal tibial fractures: A biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibial nail (PTN) // J Orthop Trauma. – 2007. – Vol. 21. – P. 701–9.
12. Josten, C., Marquass B., Schwarz C., Verheyden A. Marknagelosteosynthese proximaler Tibiafrakturen. Komplikationen und Risikofaktoren // Unfallchirurg. – 2010. – Vol. 113. – P. 21–8.
13. Nork, S. E., Barei D. P., Schildhauer T. A., Agel J., Holt S. K., Schrick J. L. et al. Intramedullary nailing of proximal quarter tibial fractures // J Orthop Trauma. – 2006. – Vol. 20. – P. 523–8.
14. Franke, J., Hohendorff B., Alt V., Thormann U.,Schnettler R. Suprapatellar nailing of tibial fractures-Indications and technique // Injury. – 2016. – № 47(2). – P. 495–501. – doi:10.1016/j.injury.2015.10.023.
15. Freedman, E. L., Johnson E. E. Radiographic analysis of tibial fracture malalignment following intramedullary nailing // Clin Orthop Relat Res. – 1995. – Vol. 315. – P. 25–33.
16. Lang, G. J., Cohen B. E., Bosse M. J. et al. Proximal third tibial shaft fractures. Should they be nailed? // Clin Orthop Relat Res. – 1995. – Vol. 315. – P. 64–74.
17. Dunbar, R. P., Nork S. E., Barei D. P. et al. Provisional plating of type III open tibia fractures prior to intramedullary nailing // J Orthop Trauma. – 2005. – № 19. – P. 412–4.
18. Tornetta, P., Collins E. Semiextended position of intramedullary nailing of the proximal tibia // Clin Orthop Relat Res. – 1996. – Vol. 328. – P. 185–9.
19. Walker, R. M., Zdero R., McKee M. D., Waddell E. H. Ideal tibial intramedullary nail insertion point varies with tibial rotation // J Orthop Trauma. – 2011. – № 25. – P. 726–730.
20. Sanders, R. W., DiPasquale T. G., Jordan C. J., Arrington J. A., Sagi H. C. Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up // J Orthop Trauma. – 2014. – № 28(5). – P. 245–255. doi:10.1097/BOT.0000000000000082.
21. Hessmann, M. H., Buhl M., Finkemeier C., Khoury A., Mosheiff R., Blauth M. Suprapatellar nailing of fractures of the tibia // Oper Orthop Traumatol. https://doi.org/10.1007/s00064-020-00649-9.
22. Brink, O. Suprapatellar nailing of tibial fractures:surgical hints // Current Orthopaedic Practice. – 2016. – Vol. 27 (1). – P. 107–112.
23. Lee, Ch., Zoller St.D., Perdue P. W., Nascone J. W. Pearls and Pitfalls With Intramedullary Nailing of Proximal Tibia Fractures // J Am Acad Orthop Surg. – 2019; 00:1–8. – DOI: 10.5435/JAAOS-D-18-00765.
24. Collinge, C. A., Beltran M. J., Dollahite H. A., Huber F. G. Percutaneous clamping of spiral and oblique fractures of the tibial shaft: A safe and effective reduction aid during intramedullary nailing // J Orthop Trauma. – 2015. – Vol. 29. – P. e208-e212.
25. Forman, J. M., Urruela A. M., Egol K. A. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures // Acta Orthop Belg. – 2001. – Vol. 77(7). – 34 s.
26. Krettek, C., Stephan C., Schandelmaier P. et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter intramedullary nails //J Bone Joint Surg Br. – 1999. – Vol. 81. – P. 963–8.
27. Ricci, W. M., O’Boyle M., Borrelli J. et al. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws // J Orthop Trauma. – 2001. – Vol. 15. – P. 264–70.
28. Zelle, B., Guilherme B. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures // Patient Safety in Surgery. – 2015. – Vol. 9, № 1.
29. Wysocki, R. W., Kapotas J. S., Virkus W. W. Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation // J Trauma. – 2009. – Vol. 66. – P. 1135–9.
30. Tornetta, P. III., Riina J., Geller J. et al. Intraarticular anatomic risks of tibial nailing // J Orthop Trauma. – 1999. – Vol. 13. – P. 247–251.
31. Gaines, R. J., Rockwood J., Garland J. et al. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing // Orthopedics. – 2013. – Vol. 36. – P. e1155–e1158.
32. Gelbke, M. K., Coombs D., Powell S. et al. Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces // J Orthop Trauma. – 2010. – Vol. 24. – P. 665–71.
References
1. Bono, C. M., Levine R. G., Rao J. P., Behrens F. F. Nonarticular proximal tibia fractures: treatment options and decision making // J Am Acad Orthop Surg. – 2001. – № 9. – P. 176–86.
2. Court-Brown, C. M., McBirnie J. The epidemiology of tibial fractures // J Bone Joint Surg Br. – 1995. – Vol. 77. – P. 417–21.
3. Hernigou, P., Cohen D. Proximal entry for intramedullary nailing of the tibia. The risk of unrecognized articular damage // J Bone Joint Surg Br. – 2000. – Vol. 82. – P. 33–41.
4. Oh, J. K., Sahu D., Hwang J. H., Cho J. W., Oh C. W. Technical pitfall while reducing the mismatch between LCP PLT and upper end tibia in proximal tibia fractures // Arch Orthop Trauma Surg. – 2010. – Vol. 130. – P. 759–63.
5. Bhandari, M., Audige L., Ellis T., Hanson B. Evidence-Based Orthopaedic Trauma Working Group. Operative treatment of extra-articular proximal tibial fractures // J Orthop Trauma. – 2003. – Vol. 17. – P. 591–5.
6. Kurylo, J. C., Tornetta P. Extra-articular proximal tibial fractures: Nail or plate. AAOS Instructional Course Lectures. – 2013. – Vol. 62. – P. 61–77.
7. Lindvall, E., Sanders R., DiPasquale T., Herscovici D., Haidukewych G., Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: Comparison of 56 cases // J Orthop Trauma. – 2009. –Vol. 23. – P. 485–92.
8. Naik, M. A., Arora G., Tripathy S. K., Sujir P., Rao S. K. Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: A prospective study // Injury. – 2013. – Vol. 44. – P. 1081–6.
9. Attal, R., Hansen M., Kirjavainen M., Bail H., Hammer O., Rosenberger R. et al. A multicenter case series of tibia fractures treated with the Expert Tibia Nail (ETN) // Arch Orthop Trauma Surg. – 2012. – Vol. 132. – P. 975–84.
10. Cannada, L. K., Anglen J. O., Archdeacon M. T., Herscovici Jr. D., Ostrum R. F. Avoiding complications in the care of fractures of the tibia // J Bone Joint Surg Am. – 2008. – Vol. 90. – P. 1760–8.
11. Hansen, M., Mehler D., Hessmann M. H., Blum J., Rommens P. M. Intramedullary stabilization of extraarticular proximal tibial fractures: A biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibial nail (PTN) // J Orthop Trauma. – 2007. – Vol. 21. – P. 701–9.
12. Josten, C., Marquass B., Schwarz C., Verheyden A. Marknagelosteosynthese proximaler Tibiafrakturen. Komplikationen und Risikofaktoren // Unfallchirurg. – 2010. – Vol. 113. – P. 21–8.
13. Nork, S. E., Barei D. P., Schildhauer T. A., Agel J.,Holt S. K., Schrick J. L. et al. Intramedullary nailing of proximal quarter tibial fractures // J Orthop Trauma. – 2006. – Vol. 20. – P. 523–8.
14. Franke, J., Hohendorff B., Alt V., Thormann U., Schnettler R. Suprapatellar nailing of tibial fractures-Indications and technique // Injury. – 2016. – Vol. 47(2). – P. 495–501. – doi:10.1016/j.injury.2015.10.023.
15. Freedman, E. L., Johnson E. E. Radiographic analysis of tibial fracture malalignment following intramedullary nailing // Clin Orthop Relat Res. – 1995. – Vol. 315. – P. 25–33.
16. Lang, G. J., Cohen B. E., Bosse M. J. et al. Proximal third tibial shaft fractures. Should they be nailed? // Clin Orthop Relat Res. – 1995; (315):64–74.
17. Dunbar, R. P., Nork S. E., Barei D. P. et al. Provisional plating of type III open tibia fractures prior to intramedullary nailing // J Orthop Trauma. – 2005. – Vol. 19. – P. 412–4.
18. Tornetta, P., Collins E. Semiextended position of intramedullary nailing of the proximal tibia // Clin Orthop Relat Res. – 1996. – Vol. 328. – P. 185–9.
19. Walker, R. M., Zdero R., McKee M. D., Waddell E. H. Ideal tibial intramedullary nail insertion point varies with tibial rotation. J Orthop Trauma 2011;25:726–730.
20. Sanders, R. W., DiPasquale T. G., Jordan C. J., Arrington J. A., Sagi H. C. Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up // J Orthop Trauma. – 2014. – Vol. 28(5). – P. 245–255. – doi:10.1097/BOT.0000000000000082.
21. Hessmann, M. H., Buhl M., Finkemeier C., Khoury A., Mosheiff R., Blauth M. Suprapatellar nailing of fractures of the tibia // Oper Orthop Traumatol. https://doi.org/10.1007/s00064-020-00649-9.
22. Brink, O. Suprapatellar nailing of tibial fractures:surgical hints // Current Orthopaedic Practice. – 2016. –Vol. 27 (1). – P. 107–112.
23. Lee, Ch., Zoller St. D., Perdue P. W., Nascone J. W. Pearls and Pitfalls With Intramedullary Nailing of Proximal Tibia Fractures // J Am Acad Orthop Surg. – 2019; 00:1–8 DOI: 10.5435/JAAOS-D-18-00765.
24. Collinge, C. A., Beltran M. J., Dollahite H. A., Huber F. G. Percutaneous clamping of spiral and oblique fractures of the tibial shaft: A safe and effective reduction aid during intramedullary nailing // J Orthop Trauma. – 2015. – Vol. 29. – P. e208–e212.
25. Forman, J. M., Urruela A. M., Egol K. A. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures // Acta Orthop Belg. – 2001. – Vol. 77(7). – 34 s.
26. Krettek, C., Stephan C., Schandelmaier P. et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter intramedullary nails // J Bone Joint Surg Br. – 1999. – Vol. 81. – P. 963–8.
27. Ricci, W. M., O’Boyle M., Borrelli J. et al. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws // J Orthop Trauma. – 2001. – Vol. 15. – P. 264–70.
28. Zelle, B., Guilherme B. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures // Patient Safety in Surgery. – 2015. – Vol. 9, № 1.
29. Wysocki, R. W., Kapotas J. S., Virkus W. W. Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation // J Trauma. – 2009. – Vol. 66. – P. 1135–9.
30. Tornetta, P. III, Riina J., Geller J. et al. Intraarticular anatomic risks of tibial nailing // J Orthop Trauma. – 1999. – Vol. 13. – P. 247–251.
31. Gaines, R. J., Rockwood J., Garland J. et al. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing // Orthopedics. – 2013. – Vol. 36. – P. e1155–e1158.
32. Gelbke, M. K., Coombs D., Powell S. et al. Suprapatellar versus infra-patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces // J Orthop Trauma. – 2010. – Vol. 24. – P. 665–71.