II Orthopaedic and Traumatologic Clinic, IRCCS - Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
Department for Life Quality Studies, University of Bologna, Bologna, Italy.
Musculoskelet Surg. 2022 Dec;106(4):469-474. doi: 10.1007/s12306-021-00726-7. Epub 2021 Aug 3.
To assess the complications and second surgeries rates at 1 year follow-up in a group of patients underwent minimally invasive fixation with screws or hybrid external fixation (HEF) for tibial plateau fractures (TPF). The hypothesis was that low Schatzker (I-IV) TPF would have shown a lower complication rate with respect to high Schatzker (V-VI) TPF.
148 patients who underwent minimally invasive surgery with screws or HEF for TPF were included and pooled in two groups: mono-condylar (Schatzker I-IV) and bi-condylar (Schatzker V-VI). The rate of second surgeries and complications, such as stiffness, infection, wound dehiscence and malunion occurred within 1 year, were reported.
Statistically significant difference between mono-condylar and bi-condylar groups was found in terms of stiffness (18% vs. 37%, p = 0.01), malunion (4% vs 21%, p = 0.004) and second surgeries (32% vs. 48%, p = 0.049). Associated procedures performed during TPF fixation increased risk of second surgeries (OR 2.1, p < 0.001). No differences in terms of second surgeries and complications were found in bi-condylar group treated with screws and HEF.
Bi-condylar TPF treated with minimally invasive surgery developed a significantly higher rates of stiffness, malunion and second surgeries within 1 year compared to mono-condylar fractures. Moreover, when an associated procedure was performed, the risk of a reoperation was nearly doubled. Trial registration number PG 0012506 CE AVEC 620/2018/Oss/IOR.
评估一组胫骨平台骨折（TPF）患者行微创螺钉或混合外固定架（HEF）固定后 1 年随访时的并发症和再次手术率。假设低 Schatzker（I-IV）TPF 的并发症发生率低于高 Schatzker（V-VI）TPF。
纳入并汇总了 148 例接受微创螺钉或 HEF 治疗 TPF 的患者，分为单髁（Schatzker I-IV）和双髁（Schatzker V-VI）两组。报告了 1 年内发生的再次手术和并发症（如僵硬、感染、伤口裂开和愈合不良）的发生率。
单髁和双髁组在僵硬（18% vs. 37%，p=0.01）、愈合不良（4% vs. 21%，p=0.004）和再次手术（32% vs. 48%，p=0.049）方面存在统计学显著差异。TPF 固定时进行的辅助手术增加了再次手术的风险（OR 2.1，p<0.001）。在接受螺钉和 HEF 治疗的双髁组中，再次手术和并发症方面无差异。
与单髁骨折相比，微创治疗的双髁 TPF 在 1 年内僵硬、愈合不良和再次手术的发生率明显更高。此外，当进行辅助手术时，再次手术的风险几乎增加了一倍。试验注册号 PG 0012506 CE AVEC 620/2018/Oss/IOR。
