High-energy fractures of the tibial plateau - Knee function after longer follow-up
High-energy fractures of the tibial plateau - Knee function after longer follow-up
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DOI：
10.2106/00004623-200209000-00006
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发表时间：
2002-09-01
影响因子：
5.3
通讯作者：
Marsh, JL
中科院分区：
文献类型：
--
作者：
Weigel, DP;Marsh, JL
背景资料：胫骨平台骨折治疗的长期结局研究包括骨折类型的广泛混合，大多数为低能量劈裂和劈裂-凹陷骨折。高能量胫骨近端关节内骨折治疗的长期结果尚不清楚。本研究的目的是评估一系列连续的胫骨平台高能量骨折患者在受伤后至少五年内的膝关节功能和关节病的发展情况，这些患者采用统一的外固定技术进行治疗。在1988年7月至1994年12月期间，三十名患者，总共三十名-1例胫骨平台骨折，采用单侧外固定架和关节面有限内固定治疗。在平均98个月时获得了23例患者24个膝关节的随访数据。20例患者（20例膝关节）专门返回研究，此时他们完成了爱荷华州膝关节评分问卷和简明健康调查表-36（SF-36）一般健康调查，进行了体格检查，并拍摄了负重X线片。14例患者的SF-36评估结果和12例膝关节评分与5年前获得的结果进行了比较，在2至4年后injure.Results：愈合后，没有患者需要二次重建程序。膝关节活动度平均为伸30 ° ~屈120 °，平均为健侧膝关节活动度的87%。平均爱荷华州膝关节评分为90分（范围：72 - 100分）。对于12名患者，之前记录的2 - 4年爱荷华州膝关节评分平均为92分，最近一次随访时的评分也是如此。13例患者将其结局评定为极好，6例为良好，3例为一般。15例患者正在工作，其中10例正在进行繁重的劳动。X线片显示，14例膝关节无关节炎证据，3例1级关节炎，3例2级关节炎，2例3级关节炎。与损伤后2 ~ 4年的影像学表现相比，18个膝关节没有进展的证据，4个膝关节有1级进展。SF-36子量表评分与年龄匹配的对照组相似。14例患者谁以前SF-36评分没有恶化这些scores.Conclusions：高能量骨折的胫骨平台外固定治疗的患者有一个良好的预后满意的膝关节功能在第二个五年受伤后。膝关节软骨似乎对损伤和轻度至中度的残余关节移位都具有耐受性，这与严重关节病的发生率低相关。
Background: Studies of the long-term outcomes of treatment of fractures of the tibial plateau have included wide mixtures of fracture types and mostly low-energy split and split-depression fractures. The long-term results of treatment of high-energy intra-articular proximal tibial fractures are unknown. The purpose of this study was to assess the function of the knee and the development of arthrosis at a minimum of five years after injury in a consecutive series of patients in whom a high-energy fracture of the tibial plateau had been treated with a uniform technique of external fixation.Methods: Between July 1988 and December 1994, thirty patients with a total of thirty-one fractures of the tibial plateau were treated with a monolateral external fixator and limited internal fixation of the articular surface. Followup data on twenty-four knees in twenty-three patients were obtained at a mean of ninety-eight months. Twenty patients (twenty knees) returned specifically for the study, at which time they completed an Iowa Knee Score questionnaire and a Short Form-36 (SF-36) general health survey, a physical examination was performed, and weight-bearing radiographs were made. The results of the SF-36 evaluations for fourteen patients and the Knee Scores for twelve were compared with those obtained five years previously, at two to four years after the injury.Results: After healing, no patient required a secondary reconstructive procedure. The range of motion of the knee averaged 3degrees of extension to 120degrees flexion, which was an average of 87% of the total arc of the contralateral knee. The average Iowa Knee Score was 90 points (range, 72 to 100 points). For twelve patients, the Iowa Knee Score previously recorded at two to four years averaged 92 points, as did the score at the time of the latest follow-up. Thirteen patients rated their outcome as excellent, six, as good, and three, as fair Fifteen patients were working, and ten of them were performing strenuous labor Radiographs showed no evidence of arthrosis in fourteen knees, grade-1 arthrosis in three, grade-2 in three, and grade-3 in two. Compared with the radiographic appearance two to four years after injury, there was no evidence of progression of arthrosis in eighteen knees and one grade of progression in four. The SF-36 subscale scores were similar to those of age-matched controls. The fourteen patients who had previous SF-36 scores had no deterioration of these scores.Conclusions: Patients with a high-energy fracture of the tibial plateau treated with external fixation have a good prognosis for satisfactory knee function in the second five years after injury. The knee joint cartilage appears to be tolerant of both the injury and mild-to-moderate residual articular displacement, which was associated with a low rate of severe arthrosis.