Central Finland Hospital, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
Oulu University Hospital, Oulu, Finland.
Arch Orthop Trauma Surg. 2022 Nov;142(11):3257-3264. doi: 10.1007/s00402-021-04150-1. Epub 2021 Aug 31.
Tibial plateau fractures are typically treated with osteosynthesis. In older patients, osteosynthesis is associated with some complications, risk of post-traumatic osteoarthritis and long partial, or non-weight bearing during the recovery phase. To avoid these problems, primary total knee replacement (TKR) has become an increasingly common treatment option. The aim of this study was to evaluate all the relevant literature and summarize the current evidence-based knowledge on the treatment of tibial plateau fractures with primary TKR in older patients.
A systematic literature search of studies on total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture was conducted using OVID Medline, Scopus, and Cochrane databases from 1946 to 18 November 2019. We included all studies without restrictions regarding total knee replacement (TKR) as primary treatment for acute traumatic tibial plateau fracture.
Of the 640 reviewed articles, 16 studies with a total of 197 patients met the inclusion criteria. No controlled trials were available, and the overall quality of the literature was low. The results, using different clinical scoring systems, were good or fair. Four-year follow-up complication (6.1%) and revision (3.6%) rates after primary TKR appeared to be lower than after secondary TKR (complication rate 20-48%, revision rate 8-20%) but higher than after elective primary TKR.
Based on low-quality evidence, TKR appears to be a useful treatment option for tibial plateau fractures in older patients. Controlled trials are mandatory to determine the relative superiority of these two options as primary treatment of tibial plateau fractures in older patients.
胫骨平台骨折通常采用内固定治疗。在老年患者中，内固定与一些并发症相关，存在创伤后骨关节炎的风险，且在恢复阶段需要长时间部分或完全不负重。为了避免这些问题，初次全膝关节置换（TKR）已成为一种越来越常见的治疗选择。本研究旨在评估所有相关文献，并总结目前关于老年患者胫骨平台骨折初次 TKR 治疗的循证医学知识。
通过 OVID Medline、Scopus 和 Cochrane 数据库，从 1946 年 11 月 18 日对初次 TKR 治疗急性创伤性胫骨平台骨折的研究进行了系统的文献检索。我们纳入了所有初次 TKR 治疗急性创伤性胫骨平台骨折的研究，不限制文献类型。
在 640 篇综述文章中，有 16 项研究共 197 例患者符合纳入标准。没有随机对照试验，文献整体质量较低。使用不同临床评分系统的结果为良好或尚可。初次 TKR 后 4 年的并发症（6.1%）和翻修（3.6%）率似乎低于二次 TKR（并发症率 20-48%，翻修率 8-20%），但高于择期初次 TKR。
基于低质量证据，TKR 似乎是老年患者胫骨平台骨折的一种有用治疗选择。需要进行对照试验以确定这两种治疗方案作为老年患者胫骨平台骨折初次治疗的相对优势。
