Department of Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK.
Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, Vancouver General Hospital, Vancouver, Canada.
Bone Joint J. 2019 Aug;101-B(8):1009-1014. doi: 10.1302/0301-620X.101B8.BJJ-2018-1288.R1.
The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) complex (Schatzker V-VI) fractures.
Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86).
Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals.
Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: 2019;101-B:1009-1014.
本研究旨在确定胫骨平台骨折固定后长达 5 年的随访过程中的恢复轨迹，包括简单（Schatzker I-IV）和复杂（Schatzker V-VI）骨折。
纳入接受切开复位内固定（ORIF）治疗的胫骨平台骨折患者，并将其纳入前瞻性数据库。使用 36 项简短健康调查身体成分综合评分（SF-36 PCS）在基线、6 个月、1 年和 5 年时采集功能结果。比较复杂骨折（Schatzker V 和 VI）和简单骨折（Schatzker I 至 IV）的恢复轨迹。计算各时间点间的最小临床重要差异（MCID）。共纳入 182 例患者：简单骨折 136 例（74.7%），复杂骨折 46 例（25.3%）。其中女性 103 例，男性 79 例，平均年龄 45.8 岁（15 至 86 岁）。
两组患者的 SF-36 PCS 评分均从 6 个月至 12 个月（p<0.001）和 1 年至 5 年（简单骨折，p=0.008；复杂骨折，p=0.007）显著改善。两组患者在 5 年均未达到基线评分。6 个月（p=0.007）和 12 个月（p=0.01）时，简单组的 SF-36 PCS 评分均显著高于复杂组，但在 5 年时无显著差异（p=0.17）。在各时间点，每组中约有 50%或更多的患者在评分变化中达到 MCID，表明病情有显著的临床改善。复杂组在最初的 6 个月内功能下降幅度较大，而在随后的时间间隔内达到 MCID 的比例相当。
胫骨平台骨折的恢复总体表现为基线功能下降，随后从 6 个月至 12 个月急剧改善，5 年内持续恢复。在简单模式中，患者在 6 个月时往往比复杂模式达到更高的功能评分。然而，只有在 5 年时两组才达到相似的功能评分，表明复杂组的恢复较晚。两组患者在 5 年内均未恢复至基线水平。这些信息有助于向患者提供关于预期恢复过程的咨询。
