Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, USA.
Injury. 2020 Apr;51(4):1097-1102. doi: 10.1016/j.injury.2020.03.003. Epub 2020 Mar 2.
To establish normative data, long-term patient-reported functional outcome and health-related quality of life (HrQoL) after operative treatment of bicondylar tibial plateau fractures. Secondly, to identify risk factors associated with functional outcome and HrQoL.
We performed a retrospective cohort study at two Level I trauma centers. All adult patients with AO/OTA 41-C or Schatzker V/ VI tibial plateau fractures treated between 2001 and 2016 (n = 450) by open reduction internal fixation (ORIF). The survey was completed by 214 patients (48%). Primary outcome was patient-reported functional outcome assessed with the PROMIS Physical Function (PROMIS PF). Secondary outcomes were HrQoL measured with the EuroQol 5-Dimensions 3-Levels (EQ-5D-3 L), infection rate, and total knee arthroplasty (TKA) rate.
Infection occurred in 26 cases (12%) and TKA was performed in 6 patients (3%). The median PROMIS PF scores was 49.8 (IQR;42-54). The median EQ-5D-3 L was 0.83 (IQR;0.78-1.0).%). The multivariable regression model revealed female gender, diabetes, and worse HrQoL were correlated with worse functional outcome. The multivariable regression model revealed smoking, diabetes, and the subsequent need for TKA to be correlated with worse HrQoL.
The PROMIS PF and EQ-5D-3L did not reach a minimum clinically important difference. The PROMIS PF items revealed patients had no difficulty in walking more than a mile or climbing a flight of stairs. However, patients were limited in doing vigorous activities and patients should be counseled about the expected long-term outcomes. This study emphasizes the correlation between injury specific functional outcome measures and general health measures.
Therapeutic Level III.
建立规范数据，长期患者报告的功能结果和健康相关生活质量（HrQoL）在双髁胫骨平台骨折的手术治疗后。其次，确定与功能结果和 HrQoL 相关的风险因素。
我们在两个一级创伤中心进行了回顾性队列研究。所有在 2001 年至 2016 年期间通过切开复位内固定（ORIF）治疗的 AO/OTA 41-C 或 Schatzker V/VI 胫骨平台骨折的成年患者（n=450）。调查由 214 名患者（48%）完成。主要结果是患者报告的功能结果，使用 PROMIS 物理功能（PROMIS PF）进行评估。次要结果是使用 EuroQol 5 维度 3 水平（EQ-5D-3L）测量的 HrQoL、感染率和全膝关节置换术（TKA）率。
26 例（12%）发生感染，6 例（3%）行 TKA。PROMIS PF 评分中位数为 49.8（IQR；42-54）。EQ-5D-3L 的中位数为 0.83（IQR；0.78-1.0）。多变量回归模型显示女性、糖尿病和较差的 HrQoL 与较差的功能结果相关。多变量回归模型显示吸烟、糖尿病和随后需要 TKA 与较差的 HrQoL 相关。
PROMIS PF 和 EQ-5D-3L 未达到最小临床重要差异。PROMIS PF 项目显示患者行走超过一英里或爬楼梯没有困难。然而，患者在剧烈活动方面受到限制，应告知患者预期的长期结果。本研究强调了损伤特异性功能结果测量与一般健康测量之间的相关性。
治疗水平 III。
