手術管理された脛骨高原骨折における患者報告アウトカムに影響を与える要因

Tibial plateau fractures are complex injuries with high complication rates, yet their broader impact on patient-reported function and quality of life remains underexplored. This study assessed the impact of demographics, fracture patterns, and treatment characteristics on patient-reported outcomes measurement information system (PROMIS) scores in patients who underwent surgical fixation of tibial plateau fractures.

A retrospective cohort study was conducted at a Level I trauma center (2022-2024) including adults with operatively treated tibial plateau fractures who completed 6-month PROMIS surveys. Exclusions were age < 18 years, non-operative or percutaneous fixation, and inadequate medical record documentation. Primary outcomes were 6-month scores for PROMIS physical function (PF), pain interference (PI), global physical health (GPH), global mental health (GMH), anxiety/depression, brief resilience scale (BRS), and percent of normal function. Outcomes were compared by sex, age, mechanism of injury, fracture pattern, Schatzker type, and external fixation.

Of 413 patients, 106 met inclusion criteria. Mean age was 50.4 years and 51.9% were male. Patients < 50 reported higher PI (62.7 vs. 59.3, p = 0.017) and lower GPH (38.8 vs. 42.4, p = 0.023). Among females, those < 50 had higher PI (64.0 vs. 58.5, p = 0.009), lower GPH (37.5 vs. 43.1, p = 0.011), and lower anxiety (60.2 vs. 64.1, p = 0.046). After adjustment, high-energy injuries were associated with worse GPH (p = 0.014), GMH (p = 0.011), depression (p = 0.009), anxiety (p = 0.015), percent of normal (p = 0.002), and BRS (p = 0.004).

Early recovery after surgically treated tibial plateau fractures varies by patient and injury characteristics: younger patients, particularly females under 50, reported worse pain and global physical health, while high-energy mechanisms were independently associated with poorer physical and psychological outcomes across multiple domains.