Watts Chad D, Larson A Noelle, Milbrandt Todd A
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Pediatr Orthop. 2016 Jul-Aug;36(5):437-9. doi: 10.1097/BPO.0000000000000476.
Stiffness is a common complication following surgically treated tibial eminence fractures. Fractures can be addressed with either open reduction and internal fixation (ORIF) or arthroscopic reduction and internal fixation (ARIF). We sought to evaluate the effects of surgical approach and other modifiable perioperative factors on postoperative arthrofibrosis. We hypothesized that ARIF would result in a lower risk of arthrofibrosis.
We retrospectively reviewed the records of all patients aged 18 years and below treated for tibial eminence fractures at our institution from 1998 to 2014. All patients were treated by either pediatric or sports fellowship-trained orthopaedic surgeons and followed until radiographic union and return of range of motion or treatment for arthrofibrosis (minimum 3 mo).
Thirty-one patients were included in our analysis, 13 in the ORIF group and 18 in the ARIF group. The groups were similar in regards to sex, age, fracture type, fixation method, and length of postoperative immobilization. However, when compared with the ORIF group, patients in the ARIF group had significantly longer time from injury to surgery (4.2 vs. 6.3 d, P=0.03), operative time (98 vs. 141 min, P=0.02), and tourniquet time (76 vs. 100 min, P=0.006). In the ARIF group, 6 (33.3%) patients acquired arthrofibrosis compared with only 1 (7.7%) patient in the ORIF group. Delaying surgery ≥7 days from injury [hazard ratio (HR)=4.7, P=0.04] and operative time ≥120 minutes (HR=9.1, P=0.03) were risk factors for arthrofibrosis. ARIF was a risk factor in univariate (HR=4.0, P=0.04), but not in multivariate (1.4, P=0.77) analysis.
Delayed surgery (≥7 d from injury) and prolonged operative times (≥120 min) were significant risk factors for arthrofibrosis. Although ARIF was not an independent risk factor, these patients were exposed to markedly longer wait times before surgery and operative times when compared with ORIF patients. ORIF is a reasonable option for treatment of displaced tibial eminence fractures. Surgeons should approach tibial eminence fractures with whichever mode they can accomplish with higher efficiency.
Level III-therapeutic study.
僵硬是手术治疗胫骨髁间棘骨折后的常见并发症。骨折可采用切开复位内固定术（ORIF）或关节镜下复位内固定术（ARIF）进行治疗。我们试图评估手术方式及其他可改变的围手术期因素对术后关节纤维化的影响。我们假设ARIF会降低关节纤维化的风险。
我们回顾性分析了1998年至2014年在我院接受治疗的所有18岁及以下胫骨髁间棘骨折患者的记录。所有患者均由小儿骨科或运动医学专科培训的骨科医生治疗，并随访至影像学愈合、活动范围恢复或接受关节纤维化治疗（至少3个月）。
我们的分析纳入了31例患者，其中ORIF组13例，ARIF组18例。两组在性别、年龄、骨折类型、固定方法及术后固定时间方面相似。然而，与ORIF组相比，ARIF组患者从受伤到手术的时间显著更长（4.2天对6.3天，P = 0.03），手术时间更长（98分钟对141分钟，P = 0.02），止血带使用时间更长（76分钟对100分钟，P = 0.006）。ARIF组有6例（33.3%）患者发生关节纤维化，而ORIF组仅有1例（7.7%）患者发生。受伤后手术延迟≥7天[风险比（HR）=4.7，P = 0.04]和手术时间≥120分钟（HR = 9.1, P =0.03）是关节纤维化的危险因素。ARIF在单因素分析中是危险因素（HR = 4.0，P = 0.04），但在多因素分析中不是（1.4，P = 0.77）。
手术延迟（受伤后≥7天）和手术时间延长（≥120分钟）是关节纤维化的重要危险因素。虽然ARIF不是独立危险因素，但与接受ORIF的患者相比，这些患者术前等待时间和手术时间明显更长。ORIF是治疗移位性胫骨髁间棘骨折的合理选择。外科医生应采用他们能更高效完成的任何方式来治疗胫骨髁间棘骨折。
三级治疗性研究。
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