Robertson Greg A J, Wong Seng J, Wood Alexander M
Greg A J Robertson, Seng J Wong, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA, United Kingdom.
World J Orthop. 2017 Jul 18;8(7):574-587. doi: 10.5312/wjo.v8.i7.574.
To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.
A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included.
Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management ( = 3); 27 reported on the outcome of surgical management ( = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) ( = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) ( = 253) and 7 on Frame-Assisted Fixation (FRAME) ( = 262). All studies recorded "return to sport" rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF.
Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.
系统回顾所有报道胫骨平台骨折后恢复运动情况的研究，以提供恢复率和恢复运动时间的相关信息，并评估不同治疗方法在运动结局方面的差异。
2017年1月，使用关键词“胫骨”“平台”“骨折”“膝关节”“运动员”“运动”“非手术”“保守治疗”“手术”“恢复运动”，对CINAHAL、Cochrane、EMBASE、谷歌学术、MEDLINE、PEDro、Scopus、SPORTDiscus和科学网进行了系统检索。纳入所有记录胫骨平台骨折后恢复率和恢复运动时间的研究。
共纳入27项研究：1项为随机对照试验，7项为前瞻性队列研究，16项为回顾性队列研究，3项为病例系列研究。1项研究报告了保守治疗的结果（n = 3）；27项报告了手术治疗的结果（n = 917）。9项研究报告了切开复位内固定术（ORIF）（n = 193），11项报告了关节镜辅助复位内固定术（ARIF）（n = 253），7项报告了框架辅助固定术（FRAME）（n = 262）。所有研究均记录了“恢复运动”率。只有1项研究记录了“恢复运动”时间。整个队列的运动恢复率为70%。保守治疗的骨折恢复率为100%。手术治疗的骨折恢复率为70%。采用ORIF治疗的骨折恢复率为60%。采用ARIF治疗的骨折恢复率为83%。采用FRAME治疗的骨折恢复率为52%。发现ARIF的恢复率显著高于ORIF（OR = 3.22，95%CI：2.09 - 4.97，P < 0.001）和FRAME（OR = 4.33，95%CI：2.89 - 6.50，P < 0.001）。ORIF和FRAME的恢复率之间未发现差异（OR = 1.35，95%CI：0.92 - 1.96，P = 0.122）。记录的恢复时间为6.9个月（中位数），来自一项关于ORIF的研究报告。
与其他骨折相比，胫骨平台骨折的运动恢复率仍然有限。ARIF提供了最佳的恢复率。关于恢复运动时间的数据有限。需要进一步研究以确定恢复运动时间，并通过优化治疗和康复来提高运动恢复率。
