关节面完整胫骨平台骨折急症与分期固定的治疗效果比较。

Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures.

机构信息

Department of Orthopaedic Surgery, University of South Florida, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL.

出版信息

J Orthop Trauma. 2023 Jun 1;37(6):294-298. doi: 10.1097/BOT.0000000000002572.

DOI:10.1097/BOT.0000000000002572

PMID:36728242

Abstract

OBJECTIVE

To determine the outcomes after acute versus staged fixation of complete articular tibial plafond fractures.

DESIGN

Retrospective cohort study.

SETTING

Single Level 1 Trauma center.

PARTICIPANTS

98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had a minimum 6 months of follow-up.

INTERVENTION

Acute open reduction internal fixation (aORIF) versus staged (sORIF) definitive fixation.

MAIN OUTCOME MEASUREMENT

Rates of wound dehiscence/necrosis and deep infection.

RESULTS

Acute (N = 40) versus staged (N = 58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs. 0%, P < 0.001), which correlated with higher American Society of Anaesthesiologist scores (>American Society of Anaesthesiologist 3: 37.5% vs. 13.8%, P = 0.02). Both groups achieved anatomic/good reductions, as determined by postoperative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs. sORIF: 121 vs. 146 minutes, P = 0.02). Postoperatively, both groups had similar rates of wound dehiscence (2.5% vs. 6.9%, P = 0.65), superficial infections (10% vs. 17.2%, P = 0.39), and deep infections (10% vs. 8.6%, P = 0.99). While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs. sORIF:12.5% vs. 25.9%, P = 0.13).

CONCLUSIONS

In select patients managed by fellowship-trained orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

比较急性与分期固定治疗完全关节面胫骨平台骨折的结果。

设计

回顾性队列研究。

地点

单一级创伤中心。

参与者

98 例骨骼成熟的 OTA/AO 43C 型骨折患者，采用钢板和螺钉固定进行确定性固定，并至少随访 6 个月。

干预

急性切开复位内固定（aORIF）与分期（sORIF）确定性固定。

主要观察指标

伤口裂开/坏死和深部感染的发生率。

结果

急性（N=40）与分期（N=58）ORIF 组的血管疾病、肾脏疾病和物质/尼古丁使用的发生率相当，但 aORIF 患者的糖尿病发生率更高（10%比 0%，P<0.001），这与更高的美国麻醉医师协会评分（>美国麻醉医师协会 3 分：37.5%比 13.8%，P=0.02）相关。两组均通过术后 CT 扫描获得大于 90%的解剖/良好复位，但 sORIF 组需要更长的手术时间才能达到这一结果（aORIF 比 sORIF：121 比 146 分钟，P=0.02）。术后，两组的伤口裂开率（2.5%比 6.9%，P=0.65）、浅表感染率（10%比 17.2%，P=0.39）和深部感染率（10%比 8.6%，P=0.99）相似。虽然每组都有 1 例患者因损伤模式本身需要游离皮瓣覆盖，但计划外游离皮瓣覆盖分别发生在 aORIF 和 sORIF 组的 10.0%和 10.3%患者中。总的来说，两组计划外再次手术率（不包括踝关节融合术）无差异（aORIF 比 sORIF：12.5%比 25.9%，P=0.13）。