Meulenkamp Brad, Martin Ryan, Desy Nicholas M, Duffy Paul, Korley Rob, Puloski Shannon, Buckley Richard
*Division of Orthopedic Surgery, University of Ottawa, Ottawa, ON, Canada; and †University of Calgary, Cumming School of Medicine, Section of Orthopaedic Surgery, Calgary, AB, Canada.
J Orthop Trauma. 2017 Mar;31(3):146-150. doi: 10.1097/BOT.0000000000000735.
To define the incidence, risk factors, and anatomic location of articular malreductions in operatively treated lateral tibial plateau fractures.
Prospective Cohort Study.
Academic Level 1 Trauma Centre.
PATIENTS/PARTICIPANTS: Study subjects were patients entered into a prospective cohort study of tibial plateau fractures.
Surgical fixation of tibial plateau fractures and postoperative computed tomographies (CTs).
The primary outcome was incidence of articular malreduction. Secondary outcomes included risk factors for malreduction and a descriptive analysis of malreduction location.
Sixty-five postoperative CTs were reviewed. Twenty-one reductions (32.3%) had a step or gap more than 2 mm. The frequency of malreductions in patients undergoing submeniscal arthrotomy or fluoroscopic-assisted reduction alone was 16.6% and 41.4%, respectively (P = 0.0021). Age, body mass index, OTA/AO fracture type, operative time, use of bone graft or bone graft substitute, and use of locking plates were not predictive of malreduction. Malreductions were heavily weighted to the posterior quadrants of the lateral tibial plateau.
When examined using cross-sectional imaging the rate of articular malreductions was high at 32.3%. Fluoroscopic reduction alone was a predictor for articular malreduction. Most malreductions were located in the posterior quadrants of the lateral plateau.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
明确手术治疗的外侧胫骨平台骨折关节复位不良的发生率、危险因素及解剖位置。
前瞻性队列研究。
一级学术创伤中心。
患者/参与者：研究对象为纳入胫骨平台骨折前瞻性队列研究的患者。
胫骨平台骨折的手术固定及术后计算机断层扫描（CT）。
主要观察指标为关节复位不良的发生率。次要观察指标包括复位不良的危险因素及对复位不良位置的描述性分析。
回顾了65份术后CT。21例复位（32.3%）存在超过2mm的台阶或间隙。单纯接受半月板下关节切开术或透视辅助复位的患者中，复位不良的发生率分别为16.6%和41.4%（P = 0.0021）。年龄、体重指数、OTA/AO骨折类型、手术时间、使用骨移植或骨移植替代物以及使用锁定钢板均不能预测复位不良。复位不良在外侧胫骨平台后象限的比例较高。
使用横断面成像检查时，关节复位不良的发生率较高，为32.3%。单纯透视复位是关节复位不良的一个预测因素。大多数复位不良位于外侧平台的后象限。
治疗性二级证据。有关证据水平的完整描述，请参阅作者指南。
