Kugelman David N, Qatu Abdullah M, Strauss Eric J, Konda Sanjit R, Egol Kenneth A
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY.
J Orthop Trauma. 2018 Nov;32(11):e421-e427. doi: 10.1097/BOT.0000000000001304.
What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures?
Prospective cohort study.
Academic medical center.
Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study.
Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis.
Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis.
At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention.
At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
哪些患者特征和损伤因素可预测胫骨平台骨折手术治疗后膝关节活动度（ROM）降低？
前瞻性队列研究。
学术医疗中心。
在11年期间，对单一学术机构的胫骨平台骨折患者进行前瞻性随访。本研究共纳入266例患者。
胫骨平台骨折的手术修复以及因关节纤维化进行的二次干预。
使用简短肌肉骨骼功能评估以及在3个月、6个月和长期随访时的ROM来评估临床结局。次要结局被视为因关节纤维化而需要进行后续手术。
在3个月随访时，平均ROM为113度。到长期随访时（平均 = 17个月），平均ROM改善至125度。膝关节ROM降低的独立预测因素如下：在3个月随访时，开放性骨折（P = 0.047）、应用跨膝关节外固定器（P = 0.026）、骨科多发伤（P = 0.003）以及胫骨棘受累（P = 0.043）；在长期随访时，非白人种族（P = 0.003）、年龄增加（P = 0.003）以及深部感染（P = 0.002）。10例患者（3.7%）因关节纤维化需要进行二次手术。干预后膝关节ROM（P < 0.001）和功能结局（P = 0.004）有显著改善。
在长期随访中，膝关节ROM降低的独立预测因素是非白人种族、年龄增加以及发生深部感染的术后并发症。二次干预是治疗关节纤维化的可靠方法。
预后性III级。有关证据水平的完整描述，请参阅作者须知。
