Riccio Anthony I, Tulchin-Francis Kirsten, Hogue Grant D, Wimberly Robert L, Gill Corey S, Collins DeRaan, Karol Lori A
Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and Children's Medical Center of Dallas, Dallas, TX.
J Pediatr Orthop. 2019 Feb;39(2):e108-e113. doi: 10.1097/BPO.0000000000001087.
Quantitative evaluation of the functional results of surgically managed tibial tubercle fractures in adolescents is unreported in the orthopaedic literature.
All patients treated surgically for unilateral tibial tubercle fractures at a single institution from 2007 to 2011 were invited to return for functional evaluation. Fractures were classified using the Ogden classification system. Clinical examination at follow-up included passive knee range of motion and thigh circumference. Side-to-side knee extension strength deficits were evaluated using a Biodex dynamometer. Patient-reported outcomes were assessed using the Pediatric-International Knee Documentation Committee Subjective Knee Form (Pedi-IKDC), Tegner-Lysholm Knee Scoring Scale, and Visual Analog Pain Scale. Chart review was performed to determine postoperative protocols including the use of physical therapy and protected weight bearing. Functional parameters were compared between the involved and uninvolved extremities using the Wilcoxon Signed Ranks Test and the Spearman correlations were performed to identify any relationships between perioperative factors, functional parameters, and subjective outcomes.
In total, 19 of 42 patients completed clinical and functional testing and 18 of 19 completed all outcome surveys. Average age at injury was 13.9 years and average follow-up was 3.0 years. There was no statistical difference in knee range of motion between sides, however, thigh circumference was slightly smaller in the injured extremity (median difference, 1.7 cm at 15 cm above the patella and 4.0 cm at 50% of the length of the thigh). In total 5/19 subjects (26%) had a significant quadriceps extension strength deficit on the involved leg compared with the contralateral side. The median Visual Analog Pain Scale for affected limbs was 8/100 and for unaffected limbs was 6/100 (P=0.017). The Tegner-Lysholm Scale revealed 9 excellent results, 5 good, 4 fair, and 1 poor (median, 90/100). Results of the Pedi-IKDC were 11 excellent, 3 good, 2 fair, and 3 poor results (median, 91/100). Outcome scores did not correlate to diminished strength or thigh circumference. No difference in outcome based upon body mass index, postoperative weight-bearing status, Ogden classification, or postoperative physical therapy was noted using regression analysis.
Despite promising objective results, clinical outcomes measured by subjective validated surveys are not all excellent.
Level III.
骨科文献中未报道过对青少年手术治疗的胫骨结节骨折功能结果的定量评估。
邀请2007年至2011年在单一机构接受单侧胫骨结节骨折手术治疗的所有患者回来进行功能评估。骨折采用奥格登分类系统进行分类。随访时的临床检查包括被动膝关节活动范围和大腿围度。使用Biodex测力计评估双侧膝关节伸展力量的差异。使用儿童国际膝关节文献委员会主观膝关节表格（Pedi-IKDC）、泰格纳-利霍尔姆膝关节评分量表和视觉模拟疼痛量表评估患者报告的结果。进行病历审查以确定术后方案，包括物理治疗和保护性负重的使用情况。使用Wilcoxon符号秩和检验比较患侧和未患侧肢体的功能参数，并进行Spearman相关性分析以确定围手术期因素、功能参数和主观结果之间的任何关系。
42例患者中有19例完成了临床和功能测试，19例中的18例完成了所有结果调查。受伤时的平均年龄为13.9岁，平均随访时间为3.0年。双侧膝关节活动范围无统计学差异，然而，受伤肢体的大腿围度略小（髌骨上方15 cm处的中位数差异为1.7 cm，大腿长度50%处的中位数差异为4.0 cm）。与对侧相比，19例受试者中有5例（26%）患侧股四头肌伸展力量有明显缺陷。患侧肢体的视觉模拟疼痛量表中位数为8/100，未患侧肢体为6/100（P = 0.017）。泰格纳-利霍尔姆量表显示9例为优，5例为良，4例为中，1例为差（中位数，90/100）。Pedi-IKDC的结果为11例优，3例良，2例中，3例差（中位数，91/100）。结果评分与力量减弱或大腿围度无关。使用回归分析未发现基于体重指数、术后负重状态、奥格登分类或术后物理治疗的结果差异。
尽管客观结果令人满意，但通过主观有效调查测量的临床结果并非都很理想。
三级。
