Berkes Marschall B, Little Milton T M, Schottel Patrick C, Pardee Nadine C, Zuiderbaan Aernout, Lazaro Lionel E, Helfet David L, Lorich Dean G
*Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; and †Department of Orthopaedic Surgery, Weill Cornell Medical College, Manhattan, NY.
J Orthop Trauma. 2014 Feb;28(2):97-102. doi: 10.1097/BOT.0b013e31829aaee1.
The purpose of this study is to report the rate of anatomic reduction, articular subsidence, and clinical outcomes for Schatzker II tibial plateau fractures treated with structural bone allografts.
This is a retrospective case series.
Academic Level I Trauma Center.
PATIENTS/PARTICIPANTS: A trauma registry was used to identify 77 Schatzker II tibial plateau fractures.
Schatzker II tibial plateau fracture open reduction internal fixation and structural bone graft using either Plexur P (N = 29) or fibular allograft (N = 48).
The primary outcome was articular subsidence. Secondary outcomes included fracture malreduction and clinical outcomes including the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, and the Short Form (SF)-36.
No patients experienced subsidence > 2mm. This rate is significantly lower than published rates for autogenous iliac crest (30.3%, P < 0.0001) and calcium phosphate cement (8.7%, P = 0.0099). The rate of fracture malreduction was 11.7% (9/77); only 4 had more than 3 mm of residual incongruity. Average outcome scores were the following: Knee Outcome Survey Activities of Daily Living Scale, 81.7; Lower Extremity Functional Scale, 78.5; SF-36 physical component, 48.3; and SF-36 mental component, 53.1. There was no difference between patients treated with Plexur P or fibula with regard to the primary or secondary outcomes.
The use of structural allograft resulted in a high rate of anatomic reduction and negligible rate of articular subsidence and good clinical outcomes in the treatment of this population of Schatzker II tibial plateau fractures. This compares favorably with historical results using nonstructural grafts.
Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.
本研究旨在报告采用结构性骨移植治疗Schatzker II型胫骨平台骨折的解剖复位率、关节塌陷率及临床疗效。
这是一项回顾性病例系列研究。
一级学术创伤中心。
患者/参与者：利用创伤登记系统识别出77例Schatzker II型胫骨平台骨折患者。
对Schatzker II型胫骨平台骨折行切开复位内固定，并使用Plexur P（n = 29）或腓骨同种异体骨（n = 48）进行结构性骨移植。
主要观察指标为关节塌陷。次要观察指标包括骨折复位不良及临床疗效，临床疗效评估采用膝关节功能评分日常生活量表、下肢功能量表及简短健康调查问卷（SF-36）。
无患者出现超过2mm的关节塌陷。该发生率显著低于自体髂嵴移植（30.3%，P < 0.0001）和磷酸钙骨水泥移植（8.7%，P = 0.0099）的已发表发生率。骨折复位不良率为11.7%（9/77）；只有4例残留不匹配超过3mm。平均疗效评分如下：膝关节功能评分日常生活量表81.7分；下肢功能量表78.5分；SF-36身体维度48.3分；SF-36心理维度53.1分。在主要或次要观察指标方面，接受Plexur P或腓骨治疗的患者之间无差异。
在治疗该组Schatzker II型胫骨平台骨折时，采用结构性骨移植可实现较高的解剖复位率，关节塌陷率可忽略不计，临床疗效良好。与使用非结构性移植的既往结果相比，效果更佳。
治疗性四级证据。有关证据级别的完整描述，请参阅作者指南。
