Menghi Amerigo, Mazzitelli Giuseppe, Marzetti Emanuele, Barberio Francesco, D'Angelo Emanuela, Maccauro Giulio
Department of Geriatrics, Neurosciences and Orthopedics, Teaching Hospital "Agostino Gemelli", Lgo A. Gemelli 1, 00168 Rome, Italy.
Department of Geriatrics, Neurosciences and Orthopedics, Teaching Hospital "Agostino Gemelli", Lgo A. Gemelli 1, 00168 Rome, Italy.
Injury. 2017 Oct;48 Suppl 3:S1-S6. doi: 10.1016/S0020-1383(17)30649-6.
Complex tibial plateau fractures are characterized by compression and sinking of one or both the articular surfaces. In this study, we evaluated clinical and radiological outcomes in patients with 41.C1,41.C2,41.C3 fractures according to AO classification. We also provide a specific therapeutic algorithm for each type of fracture.
The study was conducted in 43 patients who underwent surgical treatment for complex tibial plateau fractures and were followed for a minimum of 12 months. Outcome measures included: range of motion (ROM) recovery, Short Form 36 Health Survey (SF36), Knee injury and Osteoarthritis Outcome Score (KOOS), tibial plateau angle (TPA), and posterior angle (PA).
Analyses were performed in 38 patients after excluding 5 cases because of missing imaging evaluations at follow-up. All patients showed good quality of life in all areas considered by SF36 and KOOS as well as satisfactory recovery of ROM. Average TPA and PA values were 87.9° and 0.6°, respectively.
In complex tibial plateau fractures, surgical treatment is instrumental to obtain full restoration of the joint surface and fast functional recovery. Results are highly related to the type of treatment adopted for different kinds of fracture. In our case series, the best results were obtained when 41.C1 fractures were treated with a single plate. In 41.C2 fractures, clinical and imaging outcomes were independent of the number of plates used. In contrast, in 41.C3 fractures, optimal results were achieved with double plates.
Based on our findings, as also supported by the literature, 41.C1 fractures should be treated with single plate, which reduces the surgical time, soft tissue damage and infection risk. On the other hand, 41.C3 fractures have best outcomes in stability, consolidation and recovery time when treated with double plate.
复杂胫骨平台骨折的特征是一个或两个关节面出现压缩和塌陷。在本研究中，我们根据AO分类评估了41.C1、41.C2、41.C3型骨折患者的临床和影像学结果。我们还为每种骨折类型提供了具体的治疗方案。
本研究纳入了43例接受复杂胫骨平台骨折手术治疗且随访至少12个月的患者。观察指标包括：活动范围（ROM）恢复情况、简明健康状况调查量表（SF36）、膝关节损伤和骨关节炎疗效评分（KOOS）、胫骨平台角（TPA）和后倾角（PA）。
排除5例随访时影像学评估缺失的病例后，对38例患者进行了分析。所有患者在SF36和KOOS所考虑的所有方面均显示出良好的生活质量，ROM恢复情况也令人满意。TPA和PA的平均值分别为87.9°和0.6°。
在复杂胫骨平台骨折中，手术治疗有助于实现关节面的完全恢复和快速功能恢复。结果与针对不同类型骨折所采用的治疗方法高度相关。在我们的病例系列中，41.C1型骨折采用单钢板治疗时效果最佳。在41.C2型骨折中，临床和影像学结果与所用钢板数量无关。相比之下，在41.C3型骨折中，采用双钢板可获得最佳效果。
基于我们的研究结果，并得到文献支持，41.C1型骨折应采用单钢板治疗，这可减少手术时间、软组织损伤和感染风险。另一方面，41.C3型骨折采用双钢板治疗时，在稳定性、骨痂形成和恢复时间方面效果最佳。
