Wang Jr-Yi, Cheng Chun-Ying, Chen Alvin Chao-Yu, Chan Yi-Sheng
Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan.
Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
J Clin Med. 2020 Apr 1;9(4):973. doi: 10.3390/jcm9040973.
The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion.
Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion ( = 44) or nonunion ( = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up.
Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8-24 months).
Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.
本研究旨在呈现关节镜辅助下矫正截骨术（AACO）、复位、内固定及支撑同种异体骨移植治疗胫骨平台畸形愈合或不愈合的结果。
本研究纳入了58例患者，平均年龄49±11.9岁，其中胫骨平台畸形愈合（n = 44）或不愈合（n = 14）。有19例Schatzker II型骨折（32.7%）、2例III型骨折（3.4%）、7例IV型骨折（12%）、20例V型骨折（34.5%）和10例VI型骨折（17.2%）。平均随访期为46.2±17.6个月。临床和影像学结果采用Rasmussen系统评分。通过计算机断层扫描测量关节面塌陷情况。当随访时X线片显示受伤膝关节间隙变窄时，诊断为继发性骨关节炎。
临床评分均值从术前的15.4±3.9提高到术后的23.2±4.5。影像学评分均值从术前的7.7±2.5提高到术后的12.0±3.9。56例骨折实现了成功愈合。平均愈合时间为19.6±7.5周。术后，81%的患者临床结果为良好或优秀，62%的患者影像学结果为良好或优秀。所有受伤膝关节中有91%出现继发性骨关节炎（OA），其中25.8%为轻度OA，25.8%为中度OA，38%为重度OA。有6例深部感染（10.3%）和1例伤口边缘坏死（1.7%）。5例患者在初次手术后改行全膝关节置换，平均时间为13.5个月（范围8 - 24个月）。
关节镜辅助下矫正截骨术、复位、内固定及支撑同种异体骨移植可恢复胫骨平台畸形愈合/不愈合，影像学愈合记录良好，临床结果良好。
