Medical Imaging and Navigation in Trauma and Orthopaedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
Medical Imaging and Navigation in Trauma and Orthopaedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
Orthop Traumatol Surg Res. 2022 Nov;108(7):102922. doi: 10.1016/j.otsr.2021.102922. Epub 2021 Apr 6.
Despite a substantial improvement in the operative treatment of tibial plateau fractures, the surgical procedure remains controversial and is generally challenging, as patients may develop postoperative arthritis and functional impairment of the knee joint.
In the surgical treatment of tibial plateau fractures the intraoperative reposition quality has the greatest influence on the postoperative outcome, whereby misalignments of≥2mm lead to a worse result.
Forty-one patients with tibial plateau fractures were postoperatively examined. The operative treatment was performed under reduction control using an intraoperative 3D C-arm. The follow-up collective was divided into two groups depending on the intraoperative reduction result. The postoperative results were then evaluated using the following parameters: Lysholm score, Rasmussen score, Tegner score, SF-36 score, range of motion and pain level.
Group 1 (articular surface incongruencies<2mm) tended to achieve a better result in all scores than group 2 (articular surface incongruencies≥2mm), in the Lysholm score (p=0.039), in the comparison of the range of motion (p=0.012) and the pain level (p=0.039) this was significant. Group 1 achieved an average of 90.71 points (group 2: 78.74) in the Lysholm score. The average range of motion of the knee joint was 138.93° in group 1 (group 2: 127.78°). The average value of the current pain level in group 1 was 1.14 (group 2: 2.63).
Both study groups achieved a very good result compared to the available literature. It appears that reduction quality - which can be analyzed with intraoperative 3D imaging - plays the most important role in postoperative quality of life and functional outcome. Intraoperative adjustments of the reduction should therefore be performed on joint surface irregularities with a size above 2mm.
III; retrospective case control study.
尽管胫骨平台骨折的手术治疗有了很大的改善，但手术过程仍然存在争议，通常具有挑战性，因为患者可能会出现术后关节炎和膝关节功能障碍。
在胫骨平台骨折的手术治疗中，术中复位质量对术后结果的影响最大，其中≥2mm 的错位会导致结果更差。
对 41 例胫骨平台骨折患者进行术后检查。手术治疗在术中使用三维 C 臂进行复位控制。根据术中复位结果，将随访集分为两组。然后使用以下参数评估术后结果：Lysholm 评分、Rasmussen 评分、Tegner 评分、SF-36 评分、运动范围和疼痛程度。
在所有评分中，关节面不平整<2mm 的组 1 （n=21）的结果均优于关节面不平整≥2mm 的组 2（n=20），Lysholm 评分（p=0.039）、运动范围（p=0.012）和疼痛水平（p=0.039）差异有统计学意义。组 1 的 Lysholm 评分为 90.71 分（组 2：78.74 分）。组 1 膝关节平均运动范围为 138.93°（组 2：127.78°）。组 1 目前疼痛水平的平均数值为 1.14（组 2：2.63）。
与现有文献相比，两组研究均取得了非常好的结果。术中 3D 成像可分析的复位质量似乎在术后生活质量和功能结果中起着最重要的作用。因此，术中应调整关节面不平整>2mm 的复位。
III；回顾性病例对照研究。
