O'Neill Dillon C, Sato Eleanor H, Steffenson Lillia N, Froerer Devin L, Higgins Thomas F, Rothberg David L, Marchand Lucas S, Haller Justin M
Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, USA.
University of Utah, Salt Lake City, UT, USA.
Eur J Orthop Surg Traumatol. 2024 Dec 12;35(1):34. doi: 10.1007/s00590-024-04160-w.
Limited patient-reported outcome measurement (PROM) data exist in peri-articular trauma populations. The purpose of this study was to characterize functional mid-term PROMs and to determine relevant predictors of final PROMs and return to work following tibial plateau fracture.
Patients with a tibial plateau fracture were identified by Current Procedural Terminology (CPT) codes 27535 and 27536. Retrospective chart review was performed to verify diagnosis and collect relevant demographic and perioperative data. PROMIS PF, KOOS Activities of Daily Living (KOOS ADL), PROMIS Preference (PROPr) scores, and return to work were compared between groups. Multivariate regression was used to determine predictors of PROMs and return to work.
Two hundred and seven patients had minimum 10-month follow-up (67.9% response rate). There were 114 unicondylar and 93 bicondylar injuries. Twenty patients (9.7%) had a post-operative infection. Body mass index (BMI) (B = -0.22; p = 0.021) and post-operative infection (B = -4.3; p = 0.047) were independent predictors of PROMIS-PF. BMI (B = -0.52, p = 0.008), the presence of an ipsilateral lower extremity injury (B = 10.47, p = 0.038), diabetes (B = -10.60; 0.038), and post-operative infection (B = -10.88; p = 0.014) were independent predictors of KOOS ADL. Final PROMIS-PF, KOOS ADL, and post-operative infection were independent predictors of return to work. In a subgroup analysis, infection was associated with markedly lower rate of return to work (39% vs 81%, p = 0.001), PROMIS-PF score (39.8.4 ± 8.6 vs 46.7 ± 8.6; p = 0.002), KOOS ADL score (67.3 ± 25.3 vs 84.6 ± 17.5; p = 0.003), and PROPr score (0.33 ± 0.30 vs 0.52 ± 0.20; p = 0.003).
After operative treatment of tibial plateau fractures, post-operative infection results in large decreases in PROMs and rates of return to work that persist at mid-term follow-up. Future studies should focus on infection prevention strategies in the tibial plateau fracture population.
III.
关节周围创伤人群中患者报告结局测量（PROM）数据有限。本研究的目的是描述中期功能PROM，并确定胫骨平台骨折后最终PROM及重返工作岗位的相关预测因素。
通过现行手术操作术语（CPT）编码27535和27536识别胫骨平台骨折患者。进行回顾性病历审查以核实诊断并收集相关人口统计学和围手术期数据。比较各组之间的PROMIS身体功能（PF）、膝关节损伤和骨关节炎疗效评分系统日常生活活动（KOOS ADL）、PROMIS偏好（PROPr）评分以及重返工作岗位情况。采用多变量回归确定PROM和重返工作岗位的预测因素。
207例患者进行了至少10个月的随访（应答率67.9%）。其中单髁损伤114例，双髁损伤93例。20例患者（9.7%）发生术后感染。体重指数（BMI）（B = -0.22；p = 0.021）和术后感染（B = -4.3；p = 0.047）是PROMIS-PF的独立预测因素。BMI（B = -0.52，p = 0.008）、同侧下肢损伤的存在（B = 10.47，p = 0.038）、糖尿病（B = -10.60；0.038）和术后感染（B = -1０.88；p = 0.014）是KOOS ADL的独立预测因素。最终的PROMIS-PF、KOOS ADL和术后感染是重返工作岗位的独立预测因素。在亚组分析中，感染与显著更低的重返工作岗位率（39%对81%，p = 0.001）、PROMIS-PF评分（39.8 ± 8.6对46.7 ± 8.6；p = 0.002）、KOOS ADL评分（67.3 ± 25.3对84.6 ± 17.5；p = 0.003）和PROPr评分（0.33 ± 0.30对0.52 ± 0.20；p = 0.003）相关。
胫骨平台骨折手术治疗后，术后感染导致中期随访时PROM和重返工作岗位率大幅下降。未来研究应聚焦于胫骨平台骨折人群的感染预防策略。
Ⅲ级。
