Henry Patrick, Wasserstein David, Paterson Michael, Kreder Hans, Jenkinson Richard
*Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and †Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Orthop Trauma. 2015 Apr;29(4):182-8. doi: 10.1097/BOT.0000000000000237.
To define the rates and risk factors for reoperation and early mortality after open reduction and internal fixation (ORIF) of a tibial plateau fracture (AO type 41A-C) with or without concomitant tibial shaft fractures.
Retrospective cohort study of administrative health data (prognostic level II).
Ontario, Canada.
PATIENTS/PARTICIPANTS: Eight thousand four hundred twenty-six patients who underwent unilateral tibial plateau ORIF between 1996 and 2009.
ORIF of the tibial plateau.
Reoperation included irrigation and debridement, compartment syndrome release, amputation, knee fusion, implant removal, and repeat ORIF within 1 year of the index surgery and 90-day mortality. Outcomes were fit to a multivariate logistic regression model that included patient demographics, surgical factors, and provider factors as covariates.
The median cohort age was 48 years, with 51.5% male sex. Of all included plateau fractures, 27.9% were bicondylar fractures and 4.8% were open fractures. The odds of undergoing a repeat ORIF were increased significantly by the presence of an open fracture [odds ratio (OR) = 1.8, 1.3-25], bicondylar fracture (OR = 1.4, 1.2-1.7), an associated tibial shaft fracture (OR = 1.8, 1.3-2.5), surgery performed during the evening/weekend (OR = 1.24, 1.05-1.47), or surgery performed after midnight (OR = 2.08, 1.42-3.06). The odds of requiring an irrigation and debridement were also increased significantly by open fractures, bicondylar fractures, use of a temporizing external fixator, and an associated tibial shaft fracture [OR = 3.2 (2.2-4.6), 2.7 (2.1-3.5), 1.97 (1.09-3.56), and 3.2 (2.2-4.6), respectively]. The odds of repeat ORIF were significantly lower [0.8 (0.7-0.9)] when the index operation was performed in an academic center. Ninety-day mortality was 0.85% overall but 8.2% in patients older than 80 years.
Markers of higher energy injury are associated with higher reoperation rates and 90-day mortality after ORIF of the tibial plateau.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定伴有或不伴有胫骨干骨折的胫骨平台骨折（AO 41A-C型）切开复位内固定（ORIF）术后再次手术率和早期死亡率及其危险因素。
对行政卫生数据进行回顾性队列研究（预后性II级）。
加拿大安大略省。
患者/参与者：1996年至2009年间接受单侧胫骨平台ORIF手术的8426例患者。
胫骨平台ORIF。
再次手术包括清创、骨筋膜室综合征切开减压、截肢、膝关节融合、内固定取出以及在初次手术1年内再次行ORIF，还有90天死亡率。将结果纳入多因素逻辑回归模型，该模型将患者人口统计学特征、手术因素和医疗服务提供者因素作为协变量。
队列患者年龄中位数为48岁，男性占51.5%。在所有纳入的平台骨折中，27.9%为双髁骨折，4.8%为开放性骨折。开放性骨折（比值比[OR]=1.8，1.3-2.5）、双髁骨折（OR=1.4，1.2-1.7）、伴有胫骨干骨折（OR=1.8，1.3-2.5）、在傍晚/周末进行手术（OR=1.24，1.05-1.47）或在午夜后进行手术（OR=2.08，1.42-3.06）会使再次行ORIF的几率显著增加。开放性骨折、双髁骨折、使用临时外固定架以及伴有胫骨干骨折也会使清创的几率显著增加[分别为OR=3.2（2.2-4.6）、2.7（2.1-3.5）、1.97（1.09-3.56）和3.2（2.2-4.6）]。当初次手术在学术中心进行时，再次行ORIF的几率显著降低[0.8（0.7-0.9）]。总体90天死亡率为0.85%，但80岁以上患者为8.2%。
高能量损伤标志物与胫骨平台ORIF术后较高的再次手术率和90天死亡率相关。
预后性II级。有关证据水平的完整描述，请参阅《作者须知》。
