NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA.
Jamaica Hospital Medical Center, New York, New York, USA.
Bone Joint J. 2020 May;102-B(5):632-637. doi: 10.1302/0301-620X.102B5.BJJ-2019-1385.R1.
Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients' long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques.
In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired -test.
Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA).
Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: 2020;102-B(5):632-637.
胫骨平台骨折是一种严重的膝关节损伤，有可能影响患者的长期功能。据我们所知，这是第一项使用肌肉骨骼重点的患者报告结局（PROs）来评估使用现代技术治疗的胫骨平台骨折的长期结果与短期结果基线相比的研究。
总共确定了 102 名在大型学术医疗中心由三位骨科创伤医生之一进行手术修复并至少随访 5 年的移位胫骨平台骨折患者。按 Schatzker 分类的患者分布如下：两例（1.9%）Schatzker I 型，54 例（50.9%）Schatzker II 型，两例（1.9%）Schatzker III 型，13 例（12.3%）Schatzker IV 型，9 例（8.5%）Schatzker V 型和 26 例（24.5%）Schatzker VI 型。获得的随访数据包括：视觉模拟量表（VAS）或数字评分量表（NRS）疼痛评分、短肌肉骨骼功能评估（SMFA）和膝关节活动范围（ROM）。然后使用配对 t 检验将最新随访时的数据与 12 个月时的数据进行比较。
使用整体 SMFA 评估的患者报告的功能结果在五年时具有统计学意义的改善（p < 0.001），与同一患者的一年数据相比。患者还报告了标准化移动指数（p < 0.001）、标准化情绪指数（p < 0.001）的改善，以及标准化烦扰指数（p = 0.003）在第一年和最新随访之间的改善。五年时患者报告的疼痛和膝关节 ROM 与一年随访时相似。在最近的随访中，共有 15 名患者因膝关节接受了后续骨科手术。值得注意的是，只有一名患者因创伤后关节炎（OA）相关的平台固定后接受了膝关节置换术。
胫骨平台骨折后膝关节疼痛在一年时稳定。然而，PROs 在胫骨平台骨折后至少在统计学意义上继续改善，而不是在临床上。与一年随访相比，患者在至少五年的最低随访时，几乎在所有 SMFA 指数评分上都显示出统计学上的改善。
2020;102-B（5）：632-637.
