Song Zhe, Wang Qian, Ma Teng, Wang Chen, Yang Na, Xue Hanzhong, Li Zhong, Zhu Yangjun, Zhang Kun
Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an City, 710054, Shaanxi Province, China.
J Orthop Surg Res. 2019 Apr 24;14(1):110. doi: 10.1186/s13018-019-1147-4.
To analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same.
Twenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores.
All 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%.
The common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation.
Level IV, case series, treatment study.
分析复杂胫骨平台骨折一期手术失败的原因，并确定其翻修手术的治疗策略。
2012年1月至2016年9月，我院收治21例复杂胫骨平台骨折一期手术失败的患者。其中男性13例，女性8例，平均年龄39.4岁（27至58岁）。患者呈现不同类型的复杂胫骨平台骨折，如Schatzker V型（n = 9）、VI型（n = 12）、41.C1型（n = 9）、41.C2型（n = 6）和41.C3型（n = 6）。在仔细分析和准确评估一期手术失败原因后，为每位患者确定翻修手术的治疗策略。所有患者均采用Rasmussen影像学评分和特殊外科医院（HSS）膝关节评分进行随访。
21例患者均在平均随访32.6个月后接受了临床和影像学检查。骨折愈合的平均时间为4.5个月（3至6个月）。末次随访时，膝关节伸直的平均活动范围为2.3°，膝关节屈曲为123.8°。影像学Rasmussen评分平均为15.6分，总成功率为85.7%。HSS膝关节评分平均为84.3分，总成功率为80.9%。
复杂胫骨平台骨折一期手术失败的常见原因包括外科医生经验不足、诊断和处理不准确、植入物选择不当以及手术技术欠佳。翻修手术成功的关键因素是充分的术前评估、准确的术中操作和适当的术后康复。
IV级，病例系列，治疗研究。
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