Department of Orthopedic Surgery, New Taipei Municipal Tu-Cheng Hospital, Chang Gung Memorial Hospital, New Taipei City, Taiwan, ROC.
Comprehensive Sports Medicine Center, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan, ROC.
J Orthop Surg Res. 2023 Jun 22;18(1):448. doi: 10.1186/s13018-023-03938-8.
To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up.
This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren-Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years.
Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24-180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively.
The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation.
Level III.
本研究通过回顾性分析，探讨关节镜辅助复位内固定（ARIF）治疗复杂胫骨平台骨折的中、长期随访的影像学及预后结果。
本研究回顾性分析了 1999 年至 2019 年期间接受 ARIF 治疗的复杂胫骨平台骨折患者。测量和评估影像学结果，包括胫骨平台角（TPA）、后倾角（PSA）、Kellgren-Lawrence 分级和 Rasmussen 影像学评估。通过 Rasmussen 临床评估，对至少 2 年的随访结果进行预后和并发症评估。
共纳入 92 例连续患者（平均年龄 46.9 岁），平均随访时间为 74.8 个月（24-180 个月）。按 AO 分型，C1 型骨折 20 例，C2 型骨折 21 例，C3 型骨折 51 例。所有骨折均达到骨性愈合。最后一次随访时 TPA 平均保持良好，与术后相比无显著差异（p=0.208）。在矢状面，平均 PSA 从 9.3±2.9°增加到 9.6±3.1°（p=0.092）。C3 组 PSA 也有显著增加（p=0.044）。4 例（4.3%）发生浅表或深部感染，2 例（2.2%）因 4 级骨关节炎（OA）行全膝关节置换术（TKA）。Rasmussen 影像学评估和 Rasmussen 临床评估中，90（97.8%）和 89（96.7%）例患者结果为良好或优秀。
关节镜辅助复位内固定治疗复杂胫骨平台骨折可获得满意疗效。大多数患者并发症发生率低，临床结果良好或优秀。我们的经验表明，术后后倾角增加的发生率较高，尤其是 C3 型骨折。手术中应谨慎复位后关节面。
III 级。
