Howell Matthew, Khalid Alisa, Nelson Callum, Doonan James, Jones Bryn, Blyth Mark
Department of Orthopaedics, Inverclyde Royal Hospital, Greenock, UK.
Glasgow University, Glasgow, UK.
Knee. 2024 Dec;51:303-311. doi: 10.1016/j.knee.2024.10.003. Epub 2024 Oct 24.
Tibial plateau fractures are complex, peri-articular fractures that can have poor outcomes resulting in conversion to total knee arthroplasty (TKA). This study evaluates the 10-year survival of tibial plateau fractures treated with open reduction and internal fixation and identifies risk factors associated with conversion to TKA.
This retrospective cohort study evaluates the outcomes of 126 patients undergoing tibial plateau ORIF from January 2011 to December 2012 at Glasgow Royal Infirmary. As well as patient factors, radiographic assessments were analysed including the degree of articular depression, medial proximal tibial angle, and femoral width ratio pre-operatively, peri-operatively and at the time of union. Patients requiring further surgical intervention, including TKA, were evaluated further.
A bell-shaped distribution of patient age was observed. Schatzker II fractures were most prevalent (48%). Pre-operative articular depression averaged 6.9 mm ranging from 0.0 - 36.0 mm. Operative reduction was generally satisfactory (mean articular depression 1.3 mm, femoral width 0.96, mPTA 89.6⁰), with 82% achieving an anatomical reduction. 12 patients (9.3%) required TKA during follow-up with Kaplan-Meier calculated as 91.9% at 5 years and 87.4% at 10 years. Articular depression > 4 mm (HR = 16.2), femoral width ratio > 1.05 (HR = 14.7) and age > 50 years (HR = 4.2) at time for fracture union were independently associated with progression to TKA.
9.3% of patients required TKA within 10 years of tibial plateau ORIF, Kaplan Meier 10-year survivorship was 87.4%. Joint depression and increased tibial width at time of union and age were independent risk factors associated with need for TKA. Particular care must be taken during operative intervention to ensure adequate reduction to lower this risk.
胫骨平台骨折是复杂的关节周围骨折，其预后可能较差，最终可能需要行全膝关节置换术（TKA）。本研究评估了切开复位内固定治疗胫骨平台骨折的10年生存率，并确定了与转为TKA相关的危险因素。
这项回顾性队列研究评估了2011年1月至2012年12月在格拉斯哥皇家医院接受胫骨平台切开复位内固定术的126例患者的治疗结果。除患者因素外，还分析了影像学评估结果，包括术前、术中及骨折愈合时的关节面塌陷程度、胫骨近端内侧角和股骨宽度比。对需要进一步手术干预（包括TKA）的患者进行了进一步评估。
观察到患者年龄呈钟形分布。Schatzker II型骨折最为常见（48%）。术前关节面塌陷平均为6.9mm，范围为0.0 - 36.0mm。手术复位总体满意（平均关节面塌陷1.3mm，股骨宽度0.96，mPTA 89.6°），82%实现了解剖复位。12例患者（9.3%）在随访期间需要行TKA，根据Kaplan-Meier法计算，5年生存率为91.9%，10年生存率为87.4%。骨折愈合时关节面塌陷>4mm（HR = 16.2）、股骨宽度比>1.05（HR = 14.7）和年龄>50岁（HR = 4.2）与进展为TKA独立相关。
9.3%的患者在胫骨平台切开复位内固定术后10年内需要行TKA，Kaplan-Meier法计算的10年生存率为87.4%。骨折愈合时关节面塌陷和胫骨宽度增加以及年龄是与需要行TKA相关的独立危险因素。手术干预期间必须特别注意确保充分复位以降低这种风险。
