Konda Sanjit R, Driesman Adam, Manoli Arthur, Davidovitch Roy I, Egol Kenneth A
*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases; and†Jamaica Hospital Medical Center New York, NY.
J Orthop Trauma. 2017 Jul;31(7):387-392. doi: 10.1097/BOT.0000000000000833.
To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement.
Retrospective analysis of prospectively collected data.
Academic Medical Center.
PATIENTS/PARTICIPANTS: All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C).
Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically.
Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts.
Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P < 0.01). At 3 months postoperatively, the +TE cohort was noted to have worse knee ROM (75.16 ± 51 vs. 86.82 ± 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 ± 17 vs. 21 ± 18, P ≤ 0.01; 115.6 ± 20 vs. 124.1 ± 15, P = 0.01). By 12 months postoperatively, only knee ROM remained significantly worse in the +TE cohort (118.7 ± 15 vs. 126.9 ± 13, P < 0.01). Multivariate analysis revealed that tibial eminence involvement was a significant predictor of ROM at 6 and 12 months and SFMA at 6 months. Body mass index was found to be a significant predictor of ROM and age was a significant predictor of total SMFA at all time points.
Knee ROM remains worse throughout the postoperative period in the +TE cohort. Functional outcome improves less rapidly in the +TE cohort but achieves similar results by 1 year.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
研究累及胫骨髁间隆起的胫骨平台骨折患者的1年功能和临床结局。
对前瞻性收集的数据进行回顾性分析。
学术医疗中心。
患者/参与者：所有出现胫骨平台骨折的患者（骨科创伤协会（OTA）41 - B型和41 - C型）。
患者被分为伴有胫骨髁间隆起成分的骨折（+TE）组和不伴有该成分的骨折（-TE）组。所有患者针对骨折均采用了相似的手术入路和固定技术。没有胫骨髁间隆起骨折专门接受固定。
在术后3个月、6个月和12个月评估短肌肉骨骼功能评估（SMFA）、疼痛（视觉模拟量表）和膝关节活动范围（ROM），并在两组之间进行比较。
纳入293例患者进行分析。与OTA 41 - B型骨折相比，OTA 41 - C型骨折患者更有可能伴有胫骨髁间隆起（63%对28%，P < 0.01）。术后3个月，+TE组的膝关节ROM较差（75.16±51度对86.82±53度，P = 0.06）。在6个月时，+TE组的总SMFA和膝关节ROM明显更差（29±17对21±18，P≤0.01；115.6±20对124.1±15，P = 0.01）。到术后12个月时，只有+TE组的膝关节ROM仍然明显更差（118.7±15对126.9±13，P < 0.01）。多变量分析显示，胫骨髁间隆起受累是6个月和12个月时ROM以及6个月时SFMA的显著预测因素。发现体重指数是ROM的显著预测因素，年龄是所有时间点总SMFA的显著预测因素。
+TE组在整个术后期间膝关节ROM仍然较差。+TE组功能结局改善较慢，但到1年时取得了相似的结果。
预后III级。有关证据水平的完整描述，请参阅作者指南。
