Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldinger Str., 35043, Marburg, Germany.
Department of Trauma Surgery, Davos Hospital, Davos, Switzerland.
Arch Orthop Trauma Surg. 2019 Jul;139(7):951-959. doi: 10.1007/s00402-019-03150-6. Epub 2019 Mar 12.
Tibial plateau fractures occur frequently during downhill skiing. There is a lack of information about the outcome and development of posttraumatic osteoarthritis after internal fixation of such fractures at long-term follow-up in skiers.
A population of 83 skiers was followed up in a case series after internal fixation of intra-articular tibial plateau fractures AO-OTA 41 B1-B3 and C1-C3. Functional outcomes Visual Analog Scale, Tegner Activity Scale, Modified Lysholm Score, Hospital for Special Surgery (HSS) Knee Score and X-ray images of the affected knees (preoperative, postoperative and at time of follow-up) were obtained. Radiological evaluation focused on severity of osteoarthritis according to the Kellgren and Lawrence score of the lateral, medial and retropatellar knee compartments separately. Subgroup analyses for fracture type and age were performed separately.
Patients age was 49.8 ± 12.9 years (range 19-74 years) at the time of surgery, with a mean follow-up period of 10.3 ± 1.9 years (range 6-14 years). All tibial plateau fractures affected the lateral compartment, while the medial compartment was affected in addition as part of bicondylar fractures in two cases. Both the Tegener Activity Scale and Lysholm Score decreased significantly during the follow-up period and their median values dropped from 6 (range 3-7) to 5 (range 2-7) and from 100 (range 90-100) to 95 (range 58-100), respectively (both p < .01). The median clinical knee function at the time of follow-up revealed an HSS Knee Score of 96.5 points (range 74-100). Among the whole patient population, the radiological evaluation at follow-up revealed a significantly higher grade of osteoarthritis in all compartments of the knee joint compared to the time of the operation (p < .01). The grade of osteoarthritis in the lateral compartment was significantly higher than that in the medial and retropatellar compartments (p < .01).
In addition to physiologic aging, progression of radiologic signs of osteoarthritis following internal fixation of intra-articular tibial plateau fractures in an athletic population of skiers is most severe in the lateral knee compartment corresponding to fracture location. However, the long-term functional outcomes seem to be very satisfactory.
下坡滑雪时经常发生胫骨平台骨折。在滑雪者的长期随访中，对于此类骨折的内固定后，关于创伤后骨关节炎的结果和发展，我们知之甚少。
对 83 名滑雪者进行了一项病例系列研究，这些滑雪者在接受了关节内胫骨平台骨折 AO-OTA 41 B1-B3 和 C1-C3 的内固定后进行了随访。获得了受影响膝关节的功能结果（视觉模拟评分、Tegner 活动评分、改良 Lysholm 评分、特种外科医院（HSS）膝关节评分）和 X 射线图像（术前、术后和随访时）。放射学评估根据外侧、内侧和髌股后膝关节间隙的 Kellgren 和 Lawrence 评分分别侧重于骨关节炎的严重程度。分别对骨折类型和年龄亚组进行了分析。
患者手术时的年龄为 49.8±12.9 岁（19-74 岁），平均随访时间为 10.3±1.9 年（6-14 年）。所有胫骨平台骨折均累及外侧关节间隙，而在 2 例双髁骨折中，内侧关节间隙也受累。在随访期间，Tegener 活动评分和 Lysholm 评分均显著下降，中位数分别从 6（范围 3-7）降至 5（范围 2-7）和从 100（范围 90-100）降至 95（范围 58-100）（均 p<0.01）。随访时的膝关节临床功能中位数显示 HSS 膝关节评分为 96.5 分（范围 74-100）。在整个患者群体中，与手术时相比，在随访时的放射学评估显示膝关节所有关节间隙的骨关节炎严重程度明显更高（p<0.01）。外侧关节间隙的骨关节炎严重程度明显高于内侧和髌股后关节间隙（p<0.01）。
除了生理衰老外，在运动人群的滑雪者中，关节内胫骨平台骨折内固定后，放射学骨关节炎的进展最为严重的是与骨折部位相对应的外侧膝关节间隙。然而，长期的功能结果似乎非常令人满意。
