Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea.
Int Orthop. 2019 Jul;43(7):1685-1694. doi: 10.1007/s00264-018-4080-y. Epub 2018 Aug 8.
Treatment of a tibial plateau fracture (TPF) remains controversial and is generally challenging. Many authors report good results after conventional open reduction and internal fixation in TPF, but complications still occur. This study analyzed causes and outcomes of revision surgery for TPF. The usefulness of a flow chart for revision surgery in TPF was also evaluated.
We reviewed all patients who underwent more than two operations for a TPF between 2008 and 2015. Finally, 24 cases were selected and retrospectively investigated. The medial tibial plateau angle and proximal posterior tibial angle were radiologically evaluated. The American Knee Society Score (AKSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and bone union time were investigated after surgery.
Revision surgery for infection was performed in eight cases, for nonunion in six cases, for posttraumatic arthritis (with total knee arthroplasty) in six cases, and for other reasons in four cases. The mean clinical AKSS at final follow-up was 87.3 ± 5.3 (range, 75-95), the functional AKSS was 81.9 ± 5.5 (range, 70-90), the WOMAC score was 9.9 ± 3.1 (range, 5-16), the flexion ROM was 119.8 ± 16.5° (range, 100-150°), and the extension ROM was 2.5 ± 3.3° (range, 0-10°).
Although complications cannot be avoided in some cases, good clinical outcomes are possible when patients are divided according to the presence or absence of infection, with selection of appropriate revision surgery as shown in the flow chart. If an infection is present, treatment should be based on the presence or absence of bone union. If there is no infection, treatment should be based on the presence or absence of nonunion, post-traumatic arthritis, malunion, or immediate post-operative malreduction.
胫骨平台骨折（TPF）的治疗仍然存在争议，通常具有挑战性。许多作者报告说，传统的切开复位内固定治疗 TPF 效果良好，但仍会出现并发症。本研究分析了 TPF 翻修手术的原因和结果。还评估了 TPF 翻修手术流程图的有用性。
我们回顾了 2008 年至 2015 年间接受 TPF 两次以上手术的所有患者。最终选择了 24 例进行回顾性研究。对内侧胫骨平台角和胫骨近端后角进行影像学评估。术后调查美国膝关节协会评分（AKSS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、活动范围（ROM）和骨愈合时间。
8 例因感染行翻修手术，6 例因骨不连行翻修手术，6 例因创伤后关节炎（行全膝关节置换术）行翻修手术，4 例因其他原因行翻修手术。最终随访时的平均临床 AKSS 为 87.3±5.3（范围，75-95），功能 AKSS 为 81.9±5.5（范围，70-90），WOMAC 评分为 9.9±3.1（范围，5-16），屈曲 ROM 为 119.8±16.5°（范围，100-150°），伸展 ROM 为 2.5±3.3°（范围，0-10°）。
尽管在某些情况下无法避免并发症，但如果根据是否存在感染对患者进行分类，并根据流程图选择合适的翻修手术，仍可获得良好的临床效果。如果存在感染，应根据是否存在骨愈合来治疗。如果没有感染，应根据是否存在骨不连、创伤后关节炎、畸形愈合或术后即刻复位不良来治疗。
