Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and inter...Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.展开更多
文摘Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.
文摘目的:移位的跟骨关节内骨折是跟骨骨折最常见的类型。目前常用的为空心钉与钢板内固定两种术式,但其疗效差异尚不清楚。因此,文章对比经皮空心钉与钢板内固定对跟骨关节内骨折的修复效果。方法:计算机检索PubMed,Cochrane Library,Embase,Web of Science和中国知网数据库中关于空心螺钉与切开复位钢板内固定对跟骨骨折治疗效果的随机对照试验研究,检索时限为建库至2019年12月。按入选与排除标准筛选文献,逐一评价纳入研究的质量,提取有效结果数据,采用RevMan 5.3软件进行Meta分析。结果:共纳入15篇随机对照研究,跟骨骨折患者总计1438例,对纳入的文献进行风险偏倚评价,结果显示整体文献质量为中等偏上。Meta分析结果显示:①钢板内固定组在术后Bohler’s角(MD=0.69,95%CI:0.27-1.10,P=0.001)、术后Gissane’s角(MD=0.95,95%CI:0.16-1.74,P=0.02)方面显著优于空心钉固定组(P<0.05);②空心钉固定组在手术时间(MD=-23.92,95%CI:-25.40至-22.44,P<0.00001),术后并发症(OR=0.28,95%CI:0.19-0.41,P<0.00001)方面少于钢板内固定组(P<0.05);③但两组在跟骨高度(MD=0.43,95%CI:-0.17-1.03,P=0.16),术后AOFAS评分(MD=0.61,95%CI:-0.35-1.58,P=0.21)方面差异无显著性意义。结论:上述数据说明钢板内固定修复的跟骨骨折患者术后Bohler’s角及Gissane’s角优于空心钉固定组,但空心钉内固定技术具有手术时间短、并发症发生率低等优点。
