Scott C E H, Davidson E, MacDonald D J, White T O, Keating J F
Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK.
Bone Joint J. 2015 Apr;97-B(4):532-8. doi: 10.1302/0301-620X.97B4.34789.
Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3 months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8.
胫骨平台骨折后创伤性骨关节炎（PTOA）的放射学证据很常见，但需要全膝关节置换术的终末期关节炎则要少见得多。本研究的目的是探讨胫骨平台骨折后全膝关节置换术的适应证及疗效，并与年龄和性别匹配的原发性骨关节炎全膝关节置换术队列进行比较。1997年至2011年期间，31例连续患者（23例女性，8例男性），平均年龄65岁（40至89岁），在胫骨平台骨折后平均24个月（2至124个月）接受了全膝关节置换术。其中，24例接受了切开复位内固定术，7例接受了非手术治疗。术前以及术后6个月、12个月和60个月以上时，使用简短健康调查问卷-12、牛津膝关节评分和患者满意度评分对患者进行评估。与关节内畸形愈合的患者（50个月，p<0.001）相比，存在不稳定或骨不连的患者需要更早进行全膝关节置换术（受伤后14个月和13.3个月）。27例（87%）患者使用了初次保留交叉韧带的假体。PTOA队列的并发症发生率较高，包括伤口并发症（13%对1%，p=0.014）和持续性僵硬（10%对0%，p=0.014）。2例（6%）PTOA患者在57个月和114个月时需要进行全膝关节置换翻修术。原发性骨关节炎队列术前的平均牛津膝关节评分较差（18对30，p<0.001），但术后牛津膝关节评分或患者满意度无显著差异（原发性骨关节炎86%，PTOA 78%，p=0.437）。胫骨平台骨折后进行的全膝关节置换术比原发性骨关节炎的全膝关节置换术并发症发生率更高，但患者报告的疗效和满意度相当。引用本文：《骨与关节杂志》2015年；97-B：532-8。
