Parkkinen M, Madanat R, Mustonen A, Koskinen S K, Paavola M, Lindahl J
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
Scand J Surg. 2014 Dec;103(4):256-62. doi: 10.1177/1457496914520854. Epub 2014 Apr 15.
The indications for operative treatment of lateral tibial plateau fractures are still controversial. The objective of this study was to determine whether residual articular surface depression and valgus malalignment of plated lateral tibial plateau fractures at medium-term follow-up affect the clinical and radiographic outcomes.
A chart review of patients with operatively treated (AO type B3.1) tibial plateau fractures that were admitted to our level I trauma center between 2002 and 2008 was performed. Out of 123 patients, 73 were available to participate in a clinical and radiographic follow-up examination. The mean follow-up time was 54 months. Patients were clinically assessed and completed the Lysholm knee score and Western Ontario and McMaster Universities Osteoarthritis Index. Maximal articular surface depression, radiological mechanical axis, and degree of posttraumatic osteoarthritis were evaluated from standing radiographs.
Patients with valgus malalignment of 5° or greater at follow-up developed more advanced osteoarthritis (Kellgren-Lawrence grade 3-4) than patients with a normal mechanical axis (p = 0.006). Similarly, patients with articular depression greater than 2 mm at follow-up also developed more advanced osteoarthritis compared to patients with a depression of 2 mm or less (p = 0.001). The degree of valgus malalignment or articular depression had no effect on the Western Ontario and McMaster Universities Osteoarthritis Index or Lysholm scores.
The postoperative articular congruity and normal mechanical axis of the lower leg after plate fixation in lateral tibial plateau fractures seem to have a role in prevention of posttraumatic osteoarthritis but does not appear to predict clinical outcome at medium-term follow-up. The role of initial dislocation and associated cartilage damage in the development of osteoarthritis following these fractures is still unknown.
胫骨外侧平台骨折的手术治疗指征仍存在争议。本研究的目的是确定中期随访时，胫骨外侧平台骨折钢板固定术后残留的关节面塌陷和外翻畸形是否会影响临床和影像学结果。
对2002年至2008年入住我院一级创伤中心并接受手术治疗（AO分型B3.1）的胫骨平台骨折患者进行病历回顾。123例患者中，73例可参与临床和影像学随访检查。平均随访时间为54个月。对患者进行临床评估，并完成Lysholm膝关节评分以及西安大略和麦克马斯特大学骨关节炎指数评估。通过站立位X线片评估最大关节面塌陷、放射学机械轴以及创伤后骨关节炎的程度。
随访时外翻畸形5°或更大的患者比机械轴正常的患者发生更严重的骨关节炎（Kellgren-Lawrence分级3 - 4级，p = 0.006）。同样，随访时关节面塌陷大于2 mm的患者与塌陷2 mm或更小的患者相比，也发生了更严重的骨关节炎（p = 0.001）。外翻畸形程度或关节面塌陷对西安大略和麦克马斯特大学骨关节炎指数或Lysholm评分没有影响。
胫骨外侧平台骨折钢板固定术后的关节面一致性和小腿正常机械轴似乎在预防创伤后骨关节炎方面发挥作用，但在中期随访时似乎不能预测临床结果。这些骨折后初始脱位和相关软骨损伤在骨关节炎发展中的作用仍不清楚。
