Univerzitna Nemocnica L Pasteura, Košice, Slovakia.
P.J.Šafárik University, Faculty of Medicine, Košice, Slovakia.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):393-399. doi: 10.1007/s00068-022-02086-8. Epub 2022 Aug 29.
The aim of this study was to determine factors that affect post-operative subsidence in split-depression lateral plateau tibial fracture (OTA/AO 41B3.1) which was treated with raft construct through a locking plate.
The retrospective study evaluated all split-depression lateral plateau tibial fracture cases treated with raft construct through a locking plate between 01/2015 and 04/2020 with a minimum of 12-month follow-up. Data on the patients' age, sex, time from injury to surgery, type of plate, and use of subchondral bone defect filler were retrieved from the hospital database. The measurements of total plateau area (TPA), depressed lateral plateau area (DPA), and maximal plateau depression (MPD) were performed on the patients' pre-operative CT scans. The percentage of DPA to TPA (%DPA) was calculated. Post-operative radiographs were used for the evaluation of plateau subsidence. A subsidence greater than 2 mm was considered a failure.
There were 41 consecutive cases of split-depression lateral plateau tibial fracture in the reviewed period. Five cases were excluded, three of them were lost to follow up, 1 patient had no pre-operative CT scan and 1 had a history of cancer. A failure was identified in 11 (31%) cases. Patients in the failure group were older (61.0 vs 50.7 years, p = 0.01), and had a higher incidence of fractures extending into intercondylar eminence (100% vs 56%, p = 0.02). Multiple logistic regression identified DPA (OR = 3.6; 95%CI 1.4-9.5, p < 0.01) and age (OR = 1.2; 95% CI 1.0-1.4, p = 0.02) as predictive factors for plateau subsidence. DPA cut-off value for predicting subsidence greater than 2 mm was 5.8 cm [Area Under the ROC Curve 0.89 (95% CI 0.74-0.97), sensitivity 91%, specificity 80%, p < 0.01)].
Age and depressed lateral plateau area (DPA) in split-depression lateral plateau tibial fracture treated with raft construct through a locking plate are risk factors for post-operative subsidence greater than 2 mm.
本研究旨在确定通过锁定板使用筏形构建治疗的分裂型外侧平台胫骨骨折（OTA/AO 41B3.1）术后沉降的影响因素。
本回顾性研究评估了 2015 年 1 月至 2020 年 4 月期间通过锁定板使用筏形构建治疗的所有分裂型外侧平台胫骨骨折病例，这些病例的随访时间至少为 12 个月。从医院数据库中检索了患者的年龄、性别、受伤至手术的时间、钢板类型以及软骨下骨缺损填充物的使用等数据。在患者的术前 CT 扫描上测量总平台面积（TPA）、凹陷外侧平台面积（DPA）和最大平台凹陷（MPD）。计算 DPA 与 TPA 的百分比（%DPA）。术后 X 线片用于评估平台沉降。沉降大于 2 毫米被认为是失败。
在审查期间，有 41 例连续的分裂型外侧平台胫骨骨折病例。排除了 5 例病例，其中 3 例失访，1 例患者术前无 CT 扫描，1 例有癌症病史。在 11 例（31%）病例中发现了失败。失败组患者年龄较大（61.0 岁比 50.7 岁，p=0.01），且骨折延伸至髁间隆起的发生率较高（100%比 56%，p=0.02）。多变量逻辑回归确定 DPA（OR=3.6；95%CI 1.4-9.5，p<0.01）和年龄（OR=1.2；95%CI 1.0-1.4，p=0.02）是平台沉降的预测因素。DPA 预测沉降大于 2 毫米的截断值为 5.8 厘米[ROC 曲线下面积 0.89（95%CI 0.74-0.97），灵敏度 91%，特异性 80%，p<0.01)]。
通过锁定板使用筏形构建治疗的分裂型外侧平台胫骨骨折中，年龄和外侧平台凹陷面积（DPA）是术后沉降大于 2 毫米的危险因素。
