Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
Department of Radiological Diagnostics, Interventional Radiology and Nuclear Medicine, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
Arch Orthop Trauma Surg. 2023 Apr;143(4):1973-1980. doi: 10.1007/s00402-022-04405-5. Epub 2022 Mar 18.
Only few and inconsistent data about the impact of articular congruity and tolerable residual intraarticular steps and gaps of the joint surface after tibial plateau fractures exist. Therefore, aim of this study was to investigate the correlation between OTA type B and C tibial plateau fracture outcomes and postoperative articular congruity using computed tomography (CT) data.
Fifty-five patients with a mean age of 45.5 ± 12.5 years and treated for 27 type B and 28 C tibial plateau fractures with pre- and postsurgical CT data were included. Primary outcome measure was the correlation of postoperative intraarticular step and gap sizes, articular comminution area, the postoperative medial proximal tibial angle (MPTA), and the Lysholm and IKDC score. Receiver-operating characteristic (ROC) curves were used to determine threshold values for step and gap heights according to the following outcome scores: IKDC > 70; Lysholm > 80. Secondary outcome measures were the correlation of fracture severity, the number of complications and surgical revisions and the outcome scores, as well as the Tegner activity score before injury and at final follow-up.
After a mean follow-up of 42.4 ± 18.9 months, the mean Lysholm score was 80.7 ± 13.3, and the mean IKDC score was 62.7 ± 17.6. The median Tegner activity score was 5 before the injury and 4 at final follow-up (p < 0.05). The intraarticular step height, gap size, comminution area and MPTA deviation were significantly negatively correlated with the IKDC and Lysholm scores. The cutoff values for step height were 2.6 and 2.9 mm. The gap size threshold was 6.6 mm. In total, an average of 0.5 ± 0.8 (range 0-3) complications occurred, and on average, 0.5 ± 1.1 (range 0-7) surgical revisions had to be performed. The number of complications and surgical revisions also had negative impacts on the outcome. Neither fracture severity nor BMI or patient's age was significantly correlated with the IKDC or Lysholm score.
Tibial plateau fractures are severe injuries, which lead to a subsequent reduced level of patient activity. Precise reconstruction of the articular surface with regard to intraarticular step and gap size, residual comminution area and joint angle is decisive for the final outcome. Complications and surgical revisions also worsen it.
III.
仅有少量且不一致的数据表明关节吻合度和可接受的关节面内残余台阶和间隙对胫骨平台骨折的影响。因此，本研究的目的是使用计算机断层扫描（CT）数据来研究 OTA 分型 B 和 C 胫骨平台骨折的结果与术后关节吻合度之间的相关性。
共纳入 55 例患者，平均年龄 45.5±12.5 岁，其中 27 例为 B 型胫骨平台骨折，28 例为 C 型胫骨平台骨折，均具有术前和术后 CT 数据。主要观察指标是术后关节内台阶和间隙大小、关节粉碎面积、术后内侧胫骨近端角（MPTA）以及 Lysholm 和 IKDC 评分之间的相关性。根据以下结果评分使用接收者操作特征（ROC）曲线确定台阶和间隙高度的阈值值：IKDC>70；Lysholm>80。次要观察指标为骨折严重程度、并发症和手术翻修数量与结果评分的相关性，以及受伤前和最终随访时的 Tegner 活动评分。
平均随访 42.4±18.9 个月后，平均 Lysholm 评分为 80.7±13.3，平均 IKDC 评分为 62.7±17.6。中位数 Tegner 活动评分在受伤前为 5，在最终随访时为 4（p<0.05）。关节内台阶高度、间隙大小、粉碎面积和 MPTA 偏差与 IKDC 和 Lysholm 评分显著负相关。台阶高度的截断值为 2.6 和 2.9mm。间隙大小的阈值为 6.6mm。总共发生了平均 0.5±0.8（范围 0-3）次并发症，平均进行了 0.5±1.1（范围 0-7）次手术翻修。并发症和手术翻修的数量也对结果有负面影响。骨折严重程度、BMI 或患者年龄与 IKDC 或 Lysholm 评分均无显著相关性。
胫骨平台骨折是严重的损伤，会导致患者活动水平下降。精确重建关节面的关节内台阶和间隙大小、残余粉碎面积和关节角度对最终结果具有决定性意义。并发症和手术翻修也会使情况恶化。
III 级。
