目的:目前使用的分类系统和测量方法不足以评估骨折位移。在这项研究中,介绍了一种新的3D测量骨折位移的方法,该方法与转换为全膝关节置换术(TKA)的风险相关.
方法:进行了一项多中心横断面研究,包括2003年至2018年间997例胫骨平台骨折患者。所有患者均接受随访,534例(54%)有反应。对于所有患者来说,确定3D间隙面积以量化初始骨折位移的程度。使用ROC曲线确定截止值。进行多变量分析以评估3D间隙面积与转换为TKA的关联。确定了3D间隙面积水平增加的亚组,绘制Kaplan-Meier存活曲线以评估膝关节无TKA的存活率。
结果:共有58例(11%)患者接受了TKA的对话。初始3D间隙面积≥550mm2与转换为TKA独立相关(HR8.4;p=0.001)。确定了具有不同3D间隙面积范围的四个预后组:优秀(0-150mm2),良好(151-550mm2),中等(551-1000mm2),和差(>1000mm2)。10年随访时的固有膝关节生存率为96%,95%,76%,59%,分别,在优秀的,不错,中度,可怜的群体。
结论:开发了一种新的3D测量方法来量化胫骨平台骨折的初始骨折位移。3D断裂评估增加了当前的分类方法,在随访中确定有转换为TKA风险的患者,并可用于患者预后咨询。
方法:预后III级。
OBJECTIVE: Currently used classification systems and measurement methods are insufficient to assess fracture displacement. In this study, a novel 3D measure for fracture displacement is introduced and associated with risk on conversion to total knee arthroplasty (TKA).
METHODS: A multicenter cross-sectional study was performed including 997 patients treated for a tibial plateau fracture between 2003 and 2018. All patients were contacted for follow-up and 534 (54%) responded. For all patients, the 3D gap area was determined in order to quantify the degree of initial fracture displacement. A cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified, and Kaplan-Meier survival curves were plotted to assess survivorship of the knee free from conversion to TKA.
RESULTS: A total of 58 (11%) patients underwent conversation to TKA. An initial 3D gap area ≥ 550 mm2 was independently associated with conversion to TKA (HR 8.4; p = 0.001). Four prognostic groups with different ranges of the 3D gap area were identified: excellent (0-150 mm2), good (151-550 mm2), moderate (551-1000 mm2), and poor (> 1000 mm2). Native knee survival at 10-years follow-up was 96%, 95%, 76%, and 59%, respectively, in the excellent, good, moderate, and poor group.
CONCLUSIONS: A novel 3D measurement method was developed to quantify initial fracture displacement of tibial plateau fractures. 3D fracture assessment adds to current classification methods, identifies patients at risk for conversion to TKA at follow-up, and could be used for patient counselling about prognosis.
METHODS: Prognostic Level III.