Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany.
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3635-3641. doi: 10.1007/s00068-020-01388-z. Epub 2020 May 15.
The role of classification systems for the choice of surgical approach and the management of tibial plateau fractures remains unclear. The purpose of this study was to investigate the potential of classification systems to choose the appropriate operative approach. Current surgical management strategies were investigated in a large multicenter assessment.
In this study, we retrospectively analyzed all patients with tibial plateau fractures that have received surgical treatment in one of the five Level I trauma facilities between 2012 and 2015. Fractures were classified in each center by a senior orthopedic surgeon using the AO/OTA and the Luo classification. Demographics, trauma mechanism, as well as the surgical approach were recorded.
538 patients (46.1% male, 53.9% female) were included. The anterolateral approach was used most frequently with 54.8% of all single approaches; 76.2% of all combined approaches used anterolateral as part of the approach. Combined approaches were used in 22.5% of the cases; a combination of the anterolateral and medial (10%), anterolateral, and posteromedial approach (5.8%) were used most frequently. The lowest number was found for the posterolateral (1.3%) and the combined approaches dorsal/anterolateral and medial/dorsal (1.7%, 1.1%). The AO/OTA classification showed a peak for 41.B2 (21.9%) and B3 (35.5%) fractures. Regarding the Luo classification, the dorsal column was involved in 45.7%. In contrast, only 14.7% of the surgical approaches used were able to address the dorsal tibial plateau potentially.
The use of dorsal approach seems to be of minor importance than expected in daily clinical practice in this multicenter study. It was not possible to specify whether the AO/OTA or the Luo classification can reliably predict the choice of surgical approach. The operative treatment strategy of tibial plateau fractures seems to rather rely on the surgeons' experience, education, and preferences.
分类系统在选择手术入路和胫骨平台骨折治疗中的作用仍不清楚。本研究旨在探讨分类系统在选择合适手术入路方面的潜力。通过大型多中心评估研究了当前的手术治疗策略。
在这项研究中，我们回顾性分析了 2012 年至 2015 年间在五个一级创伤中心接受手术治疗的所有胫骨平台骨折患者。每个中心的骨折均由一名资深骨科医生使用 AO/OTA 和 Luo 分类进行分类。记录患者的人口统计学、创伤机制以及手术入路。
共纳入 538 例患者（男性 46.1%，女性 53.9%）。最常使用前外侧入路，所有单一入路中占 54.8%；所有联合入路中，前外侧入路占 76.2%。联合入路占 22.5%；最常使用前外侧和内侧（10%）、前外侧和后内侧（5.8%）联合入路。后外侧（1.3%）和后外侧/前外侧和内侧/后外侧（1.7%，1.1%）联合入路使用最少。AO/OTA 分类显示 41.B2（21.9%）和 B3（35.5%）骨折的发病率最高。根据 Luo 分类，后柱受累占 45.7%。相比之下，只有 14.7%的手术入路能够解决潜在的胫骨平台后侧面。
在这项多中心研究中，与预期相比，背侧入路的使用似乎并不重要。尚无法确定 AO/OTA 或 Luo 分类是否能够可靠地预测手术入路的选择。胫骨平台骨折的手术治疗策略似乎更依赖于外科医生的经验、教育和偏好。
