放射学结果指标表明，预塑形锁定加压钢板在老年胫骨外侧平台劈裂凹陷骨折（AO41B3）患者中具有优势。
Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3).
作者信息
Prall Wolf C, Kusmenkov Thomas, Rieger Maximilian, Haasters Florian, Mayr Hermann O, Böcker Wolfgang, Fürmetz Julian
机构信息
Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria.
Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
出版信息
Geriatr Orthop Surg Rehabil. 2021 Oct 13;12:21514593211043967. doi: 10.1177/21514593211043967. eCollection 2021.
BACKGROUND
Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients.
METHODS
The hospital's database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients' records were analyzed. Patients were attributed as young (18-49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters.
RESULTS
Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS = 6.9 ± 1.6, RRS = 8.5 ± 1.5, = .015; MPTA = 91.5 ± 1.9°, MPTA = 89.1 ± 2.1°, = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS = 5.7 ± 1.6, RRS = 8.2 ± .8, < .001; MPTA = 92.6 ± 4.2°, MPTA = 89.2 ± 1.4°, = .002).
CONCLUSION
Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.
背景
胫骨外侧平台劈裂凹陷骨折（AO41B3）常伴有严重的关节面破坏。预塑形锁定加压钢板（LCP）旨在为复位后的关节面提供最佳支撑，尤其在骨质较差的情况下受到特别关注。然而，目前仍缺乏证据支持其在老年患者中的广泛应用。因此，本研究旨在探讨AO41B3骨折在年轻患者与老年患者中使用特定植入物后的影像学结果。
方法
在医院数据库中筛选孤立的AO41B3骨折、切开复位内固定术（ORIF）以及影像学随访时间≥12个月的病例。对CT扫描、X线片和患者记录进行分析。将患者分为年轻组（18 - 49岁）和老年组（≥50岁）。进一步根据是否使用预塑形LCP和传统植入物进行亚组划分。将12个月后的Rasmussen影像学评分（RRS）作为主要结局参数。术后RRS以及术后和12个月后的胫骨近端内侧角（MPTA）作为次要结局参数。
结果
共纳入59例连续患者（26例年轻患者，年龄38.2±7.8岁；33例老年患者，年龄61.3±9.4岁）。外侧关节面骨折块的平均大小和凹陷深度在两组间无显著差异。在按植入物类型进行亚组划分之前，影像学结局指标显示年轻患者（RRS = 7.7±1.7；MPTA = 90.3±2.3°）和老年患者（RRS = 7.2±1.7；MPTA = 90.5±3.3°）之间无显著差异。按植入物类型进行亚组划分后，影像学结果显示使用传统植入物的年轻患者结局明显较差（RRS = 6.9±1.6, RRS = 8.5±1.5, P = 0.015；MPTA = 91.5±1.9°, MPTA = 89.1±2.1°, P = 0.01）。这种影响在老年患者中更为明显，与预塑形LCP相比，使用传统植入物的老年患者影像学结局指标显著恶化（RRS = 5.7±1.6, RRS = 8.
Zotero 插件