Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases
Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases
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DOI：
10.1007/s00264-009-0790-5
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发表时间：
2010-04-01
影响因子：
2.7
通讯作者：
Giannoudis, Peter
中科院分区：
文献类型：
--
作者：
Manidakis, Nikolaos;Dosani, Anis;Giannoudis, Peter
胫骨平台骨折的发生是由于轴向负荷和内翻/外翻外力的共同作用，导致关节凹陷、排列不齐和创伤后骨关节炎(OA)风险增加[14，19]。在治疗关节内骨折时，目标是获得稳定的关节，允许早期活动范围，以利于软骨的滋养和保存[19]。多年来，人们使用了各种治疗方法，结果喜忧参半。这些包括牵引[3]或闭合治疗与铸型支撑[9，16]。外科手术包括圆形框架[1，2，18]，经皮螺钉固定[17]，切开复位/内固定(ORIF)[1，5，6，10，28]和关节成形术。更新的技术，如使用固定角度装置[12，20]，关节镜辅助复位[8]，钙基水泥强化[26，29]和使用新的移植方法来解决关节凹陷[4]，不断在骨科医生中流行。防止负重和固定长度在作者中受到不同的重视[2，11，27]。尽管解剖关节重建，骨关节炎的发展仍可能继发于最初的关节软骨和半月板损伤[14，21]。对于年轻患者来说，这可能是有害的，因为它可能导致在早期进行全膝关节置换术(TKR)。此外，这些裂缝可能会对社会经济产生重大影响，主要是因为休假时间。为了评估这些损伤对骨性关节炎的功能结局和发展的影响，我们回顾了我们机构治疗的一系列胫骨平台骨折。
Tibial plateau fractures occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of posttraumatic osteoarthritis (OA)[14, 19]. When treating intra-articular fractures, the goal is to obtain a stable joint permitting early range of motion for cartilage nourishment and preservation [19]. Various treatment modalities have been used over the years, with mixed results. These include traction [3] or closed treatment with cast bracing [9, 16]. Surgical procedures including circular frames [1, 2, 18], percutaneous screw fixation [17], open reduction/internal fixation (ORIF)[1, 5, 6, 10, 28] and arthroplasty have also been advocated. More recent techniques such as the use of fixed angle devices [12, 20], arthroscopically-assisted reduction [8], calcium based cement augmentation [26, 29] and the use of novel grafting methods to address articular depression [4], constantly gain popularity amongst orthopaedic surgeons. Protection from weight bearing and length of immobilisation receive varied emphasis among authors [2, 11, 27]. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury [14, 21]. In young patients this could be detrimental as it can lead to total knee replacement (TKR) at an early age. In addition, these fractures may have significant socio-economic influence, mainly due to time taken off work. In order to assess the effect of these injuries on functional outcome and development of OA, we retrospectively reviewed a series of tibial plateau fractures treated in our institution.