Garabano Germán, Perez Alamino Leonel, Rodriguez Joaquín, Alonso Manuel, Angel Pesciallo Cesar
Department of Orthopaedic and Traumatology, British Hospital of Buenos Aires, Buenos Aires, Argentina.
J Clin Orthop Trauma. 2024 Jul 3;54:102491. doi: 10.1016/j.jcot.2024.102491. eCollection 2024 Jul.
Restoring joint congruence and maintaining reduction until healing is imperative in treating tibial plateau fractures (TPF). The main objective of this study was to evaluate the feasibility of augmentation with impacted bone allograft (IBA) to prevent loss of reduction in tibial plateau fractures during healing and to evaluate its incorporation.
We retrospectively analyzed all patients with an acute, closed tibial plateau fracture (Schatzker II, III, IV) treated between 2010 and 2019 with open reduction and internal fixation (ORIF) and impacted bone allograft (IBA), with a minimum follow-up of 24 months. We evaluated the postoperative radiographs by drawing a line along the tibial axis and another perpendicular to the healthy plateau to measure the reduction and subsequent behavior. The incorporation of the allograft was evaluated by radiological analysis assessing its integration, non-union, resorption, or sclerosis. We used the clinical-radiological Rasmussen system and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to objectify the outcomes.
78 TPFs were included, with a median age of 51.5 (40.7-62.2) years and a median follow-up of 66 (24-89) months. Two (2.5 %) patients presented loss of joint reduction (subsidence) during the follow-up regarding the achieved in the surgery. Seventy-six (94.7 %) patients presented integration, two (2.5 %) resorption, and one (1.3 %) sclerosis. Seventy-two (92.3 %) patients presented excellent and good results in the Rasmussen radiological score, and 72 (92.3 %) patients presented excellent or good clinical scores. The mean WOMAC at two years postoperatively was 15 ± 6.5.
Our results demonstrate that allograft is an adjuvant in maintaining a reduction in type II, III, and IV Schatzker's tibial plateau fractures. Low rates of loss of reduction during follow-up can be expected with its use.
恢复关节一致性并在愈合前维持复位对于治疗胫骨平台骨折（TPF）至关重要。本研究的主要目的是评估采用嵌压式同种异体骨移植（IBA）进行增强以防止胫骨平台骨折愈合期间复位丢失的可行性，并评估其融合情况。
我们回顾性分析了2010年至2019年间接受切开复位内固定（ORIF）和嵌压式同种异体骨移植（IBA）治疗的所有急性、闭合性胫骨平台骨折（Schatzker II、III、IV型）患者，最短随访24个月。我们通过沿胫骨轴线画一条线和另一条垂直于健康平台的线来评估术后X线片，以测量复位情况及随后的变化。通过放射学分析评估同种异体骨的融合情况，评估其整合、不愈合、吸收或硬化情况。我们使用临床放射学Rasmussen系统和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）来客观评估结果。
纳入78例TPF患者，中位年龄51.5（40.7 - 62.2）岁，中位随访66（24 - 89）个月。两名（2.5%）患者在随访期间出现相对于手术时实现的关节复位丢失（下沉）。76例（94.7%）患者出现融合，2例（2.5%）出现吸收，1例（1.3%）出现硬化。72例（92.3%）患者在Rasmussen放射学评分中表现为优和良，72例（92.3%）患者临床评分表现为优或良。术后两年的平均WOMAC评分为15 ± 6.5。
我们的结果表明，同种异体骨移植是维持Schatzker II、III和IV型胫骨平台骨折复位的辅助手段。使用它可预期随访期间复位丢失率较低。
