Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
J Orthop Trauma. 2010 Aug;24(8):499-504. doi: 10.1097/BOT.0b013e3181c8ad52.
To assess the recovery of ankle function and general health status at multiple time points during the first 24 months after an isolated tibial plafond fracture treated with joint-spanning external fixation and to determine factors that affect a rapid versus a slow recovery and factors that influence patient outcome at a minimum of 2 years after injury.
Prospective observational study.
Two Level I trauma centers.
Forty-three patients (mean age, 42 years; range, 20-60 years) with unilateral fractures of the tibial plafond were prospectively assessed. These 43 patients had a 24 month follow up and were seen for at least three additional scheduled visits before the 24-month follow up.
Spanning articulated external fixator and follow ups at defined time intervals after injury to track the progress of the outcome measures over time.
The Short Form Health Survey (SF-36) Medical Outcomes Study (MOS) version 2 Physical Component Summary Score (PCS) and Mental Component Summary Score (MCS) and the Ankle Osteoarthritis (AOS) Pain and Disability Scales.
Early after injury, the MCS was not as negatively affected as the PCS. By 6 months after injury, the MCS had improved to be equivalent to age-matched norms and remained there at 2 years after injury. The PCS was more severely compromised and did not level off until the 12-month clinic visit. At 2 years, the PCS remained on average one standard deviation below age-matched normal. Although not statistically significant, both the average pain and disability AOS scales deteriorated between 6 and 12 months, suggesting some patients actually perceived their ankle as being worse as they begin walking on their injured ankle. Between 12 and 24 months, they trended toward improvement in both the pain and function scales. However, their ankle continued to have dramatically increased pain and decreased function compared with population-based norms.
In patients recovering from a tibial plafond fracture that was treated with joint-spanning external fixation, the MCS improves quickly and completely, whereas the PCS often takes 1 full year or longer to reach maximal improvement and does not completely recover, because it remains on average one standard deviation below normal at 2 years after injury. Changes in the AOS pain and disability scales between 6 and 12 months after injury were not significantly different but at all time points, the patient's ankle pain and function remains dramatically different than the normal population. These results can be used in future studies for comparison with patients treated with alternate treatment techniques and to assess the effect of important treatment variables such as stabilization techniques and quality of reduction.
评估关节跨越外固定架治疗的孤立性胫骨平台骨折患者在伤后 24 个月内多个时间点的踝关节功能恢复和总体健康状况，并确定影响快速恢复和缓慢恢复的因素，以及影响伤后至少 2 年患者结局的因素。
前瞻性观察研究。
两个一级创伤中心。
43 例（平均年龄 42 岁；范围，20-60 岁）单侧胫骨平台骨折患者前瞻性评估。这 43 例患者接受了 24 个月的随访，并在 24 个月随访前至少进行了 3 次定期随访。
关节跨越式 articulated 外固定架和受伤后定义的时间间隔进行随访，以跟踪随时间推移的结果测量值的进展。
简明健康调查量表（SF-36）医学结局研究（MOS）第 2 版生理成分综合评分（PCS）和心理成分综合评分（MCS）和踝关节骨关节炎（AOS）疼痛和残疾量表。
伤后早期，MCS 的影响不如 PCS 严重。受伤后 6 个月，MCS 已改善至与年龄匹配的正常值相当，并在伤后 2 年保持不变。PCS 受到更严重的损害，直到 12 个月的临床就诊才趋于平稳。在 2 年时，PCS 平均仍低于年龄匹配的正常值一个标准差。尽管没有统计学意义，但 AOS 平均疼痛和残疾量表在 6 至 12 个月之间恶化，表明一些患者在开始用受伤的踝关节行走时实际上感觉到他们的踝关节变得更糟。在 12 至 24 个月期间，疼痛和功能量表均呈改善趋势。然而，与基于人群的正常值相比，他们的踝关节仍然疼痛明显增加，功能明显下降。
在关节跨越外固定架治疗的胫骨平台骨折患者中，MCS 恢复迅速且完全，而 PCS 通常需要 1 年或更长时间才能达到最大改善，并且在伤后 2 年仍未完全恢复，因为平均仍低于正常值一个标准差。伤后 6 至 12 个月时 AOS 疼痛和残疾量表的变化没有显著差异，但在所有时间点，患者的踝关节疼痛和功能与正常人群明显不同。这些结果可用于未来的研究，与采用不同治疗技术治疗的患者进行比较，并评估稳定技术和复位质量等重要治疗变量的效果。
