Dept. Trauma Surgery, University Hospital Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Knee. 2021 Jun;30:41-50. doi: 10.1016/j.knee.2021.03.011. Epub 2021 Apr 10.
Posterior tibial plateau fractures (PTPF) have a high impact on functional outcome and the optimal treatment strategy is not well established. The goal of this study was to assess the relationship between trauma mechanism, fracture morphology and functional outcome in a large multicenter cohort and define possible strategies to improve the outcome.
An international retrospective cohort study was conducted in five level-1 trauma centers. All consecutive operatively treated PTPF were evaluated. Preoperative imaging was reviewed to determine the trauma mechanism. Patient reported outcome was scored using the Knee injury and Osteoarthritis Outcome Score (KOOS).
A total of 145 tibial plateau fractures with posterior involvement were selected with a median follow-up of 32.2 months (IQR 24.1-43.2). Nine patients (6%) sustained an isolated posterior fracture. Seventy-two patients (49%) sustained a two-column fracture and three-column fractures were diagnosed in 64 (44%) patients. Varus trauma was associated with poorer outcome on the 'symptoms' (p = 0.004) and 'pain' subscales (p = 0.039). Delayed-staged surgery was associated with worse outcome scores for all subscales except 'pain'. In total, 27 patients (18%) were treated with posterior plate osteosynthesis without any significant difference in outcome.
Fracture morphology, varus trauma mechanism and delayed-staged surgery (i.e. extensive soft-tissue injury) were identified as important prognostic factors on postoperative outcome in PTPF. In order to assess possible improvement of outcome, future studies with routine preoperative MRI to assess associated ligamentous injury in tibial plateau fractures (especially for varus trauma) are needed.
胫骨平台后髁骨折（PTPF）对功能结果有很大影响，其最佳治疗策略尚未确定。本研究的目的是评估在一个大型多中心队列中创伤机制、骨折形态与功能结果之间的关系，并确定可能改善结果的策略。
在五个 1 级创伤中心进行了一项国际回顾性队列研究。评估了所有接受手术治疗的 PTPF。对术前影像学进行了回顾，以确定创伤机制。使用膝关节损伤和骨关节炎结果评分（KOOS）评估患者报告的结果。
共选择了 145 例累及后髁的胫骨平台骨折，中位随访时间为 32.2 个月（IQR 24.1-43.2）。9 例（6%）患者发生单纯后髁骨折，72 例（49%）患者发生双柱骨折，64 例（44%）患者发生三柱骨折。内翻创伤与“症状”（p=0.004）和“疼痛”（p=0.039）亚量表的较差结果相关。延迟分期手术与除“疼痛”以外的所有亚量表的结果评分较差相关。总共 27 例（18%）患者接受了后钢板内固定治疗，结果无显著差异。
骨折形态、内翻创伤机制和延迟分期手术（即广泛的软组织损伤）是 PTPF 术后功能结果的重要预后因素。为了评估可能的改善结果，未来需要进行常规术前 MRI 评估，以评估胫骨平台骨折（尤其是内翻创伤）相关的韧带损伤。
