Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China.
J Orthop Surg Res. 2023 Jun 7;18(1):412. doi: 10.1186/s13018-023-03887-2.
The objective of this study was to investigate the effect of proximal fibular and/or posterolateral joint facet (PJF) fractures on early functional recovery after Schatzker type VI tibial plateau fractures (TPFs).
Seventy-nine patients with Schatzker type VI TPFs sustained from November 2016 to February 2021 were divided into three groups according to the integrity of the proximal fibula and PJF (groups A, B, and C). Details including demographics, duration of surgery, and complications were recorded. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score, Hospital for Special Surgery (HSS) score, lateral knee pain and lateral hamstring tightness were ascertained at the final follow-up. The HSS and WOMAC scores have high reliability in evaluating knee function and osteoarthritis.
There was a significant difference in the HSS score between groups A and C (P < 0.001) and between groups B and C (P = 0.036). The hospital stay was significantly different between groups A and C (P = 0.038) and between groups B and C (P = 0.013). There was a significant difference in lateral knee pain and lateral hamstring tightness between groups A and C (P < 0.001) and between groups B and C (P < 0.001).
Our study demonstrates that proximal fibular and PJF fractures do not increase the time from injury to surgery, the incidence of complications, or the duration of surgery for Schatzker type VI TPFs. However, fractures of the proximal fibula significantly increase the hospital stay, reduce knee function, and cause lateral knee pain and lateral hamstring tightness. Combined proximal fibular fracture is more decisive than PJF involvement for prognosis.
本研究旨在探讨腓骨近端和/或后外侧关节面（PJF）骨折对 Schatzker 型 VI 胫骨平台骨折（TPF）患者术后早期功能恢复的影响。
2016 年 11 月至 2021 年 2 月，根据腓骨近端和 PJF 的完整性，将 79 例 Schatzker 型 VI TPF 患者分为 3 组（A、B 和 C 组）。记录患者的人口统计学资料、手术时间和并发症等详细信息。末次随访时，采用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评分、美国特种外科医院（HSS）评分、膝关节外侧疼痛和外侧腘绳肌紧张度评估膝关节功能。HSS 和 WOMAC 评分在评估膝关节功能和骨关节炎方面具有较高的可靠性。
A 组和 C 组（P<0.001）、B 组和 C 组（P=0.036）的 HSS 评分存在显著差异。A 组和 C 组（P=0.038）、B 组和 C 组（P=0.013）的住院时间存在显著差异。A 组和 C 组（P<0.001）、B 组和 C 组（P<0.001）的膝关节外侧疼痛和外侧腘绳肌紧张度存在显著差异。
本研究表明，腓骨近端和 PJF 骨折并不会增加 Schatzker 型 VI TPF 患者的从受伤到手术的时间、并发症发生率或手术时间。然而，腓骨近端骨折会显著增加住院时间，降低膝关节功能，并导致膝关节外侧疼痛和外侧腘绳肌紧张。与单独的腓骨近端骨折相比，合并的腓骨近端骨折对预后的影响更为显著。
