Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
Department of Orthopedics, Jinnah Post Graduate Medical Center, Karachi, Pakistan.
J Pak Med Assoc. 2021 Aug;71(Suppl 5)(8):S8-S12.
Tibial plateau is an important weight bearing surface and its fractures are the result of axial compressive forces. Post-traumatic osteoarthritis (PTOA) occurs despite anatomical joint reconstruction. In this study we determined the incidence of PTOA after primary management of tibial plateau fractures and determined the risk factors of PTOA of patients whose results were published at 24 months and now we present a five year follow up of the same patients.
In this study, we presented the prospective data of 109 patients who were managed for tibial plateau fractures, from August 2009 to June 2018 a Jinnah postgraduate medical centre. Data of patients regarding clinical and radiological, functional outcome (according to the American Knee Society criteria), post-procedural visual analogue scale (VAS) pain score was included. Incidence of development of PTOA was noted in each patient using the Ahlbäck classification.
Out of 109 patients with tibial plateau fractures, 81 (74.3%) were male and 28 (25.7%) were female. Mean time lag from injury to surgery was 10.14±9.07 days. Overall incidence of osteoarthritis was 50 (45.9%). Advanced age >50 years (odds ratio 9.1 (3.7-22.1), p-value <0.0001), female gender (odds ratio; 3.40 (1.36-8.46), p-value 0.007), VAS score >4 ((odds ratio; 73.28 (15.7-341.5), p-value <0.001)), Articular depression (odds ratio; 35.25 (11.49-108.1), p-value <0.001) and degree of mal-alignment (odds ratio; 25.72 (9.30-71.12), p-value <0.001) were found to be the risk factors of PTOA. While excellent functional outcomes were protective for PTOA (odds ratio; 4.8, p-value <0.001). Thirty out of fifty patients (60%) suffering from secondary arthritis of the knee required knee replacement (TKR). Twenty-one patients (70%) were males that underwent TKR.
There is a high proportion of osteoarthritis following tibial plateau fixation. The risk factors that related to the development of secondary arthritis our cohorts were increased age, male gender, a decrease in AKSS and a higher VAS group. Knee arthroplasty is the only option for our cohorts with severe posttraumatic arthritis.
胫骨平台是一个重要的承重面，其骨折是轴向压缩力的结果。即使进行了解剖关节重建，创伤后骨关节炎（PTOA）仍会发生。在这项研究中，我们确定了初次治疗胫骨平台骨折后 PTOA 的发生率，并确定了结果发表于 24 个月且现在我们对同一批患者进行了五年随访的患者 PTOA 的危险因素。
在这项研究中，我们展示了 2009 年 8 月至 2018 年 6 月期间在 Jinnah 研究生医学中心接受胫骨平台骨折治疗的 109 名患者的前瞻性数据。纳入了患者的临床和影像学、功能结果（根据美国膝关节协会标准）、术后视觉模拟量表（VAS）疼痛评分的数据。使用 Ahlbäck 分类法在每位患者中注意到 PTOA 发展的发生率。
在 109 例胫骨平台骨折患者中，81 例（74.3%）为男性，28 例（25.7%）为女性。从受伤到手术的平均时间间隔为 10.14±9.07 天。总体骨关节炎发生率为 50 例（45.9%）。年龄较大>50 岁（优势比 9.1（3.7-22.1），p 值<0.0001）、女性（优势比；3.40（1.36-8.46），p 值 0.007）、VAS 评分>4（（优势比；73.28（15.7-341.5），p 值<0.001））、关节凹陷（优势比；35.25（11.49-108.1），p 值<0.001）和对线不良程度（优势比；25.72（9.30-71.12），p 值<0.001）被发现是 PTOA 的危险因素。而优秀的功能结果对 PTOA 具有保护作用（优势比；4.8，p 值<0.001）。五十名（60%）患有膝关节继发性关节炎的患者需要膝关节置换术（TKR）。二十一名（70%）接受 TKR 的患者为男性。
胫骨平台固定后发生骨关节炎的比例很高。与我们队列中继发性关节炎发展相关的危险因素是年龄增加、男性、AKSS 降低和 VAS 升高。对于严重创伤后关节炎的患者，膝关节置换术是唯一的选择。
