| Background and Objectives: Tibial plateau fracture is an intra-articular fracture of the knee. The treatment of this fracture will affect the function of the knee .The therapy has improved very much so far, but the complication often occur. Recently, the study of the tibial plateau fracture focuses on the selection of the therapy. There is rarely discussion about the relation between the reduction in plateau and function of the knee after treatment of the tibial plateau fracture. How to accurately assess the amount of the displacement? What is the eventual outcome of the articular injury with residual displacement. There is not enough data to support that an anatomic reduction is necessary to regain the function of knee. This study firstly demonstrates the reduction after treatment of the tibial plateau fracture by plain radiographs and spiral CT scans and assesses the function of the knee by following-up, and then objectively assesses the relation of them.Methods: This study was a prospective and sequential clinical trial. The cases were chosen from the patients who were treated in Department of orthopedics, 1st People's Hospital of Chenzhou City, Hunan, from Jan, 2005 to Sept, 2006. The diagnosis was confirmed by plain radiographys and spiral CT scans. Thirty-three cases of 44 patients with tibial plateau fracture were chosen according to inclusion criteria. The plain radiographs and spiral CT scans were made sequentially after treatment of the 33 cases. The imaging score was made according to the parameters of articular reduction, including fragment displacement﹑damage area and smash of plateau. The knee function was assessed by Rasmussen Knee Evaluation System. The comparison was carried out between the outcomes of the plain radiographs and the spiral CT scans. The function of the knee of the injuried limb were assessed by 6, 12, 18 months of follow-up after treatment. The relation between the imaging score and function score was analyzed by Spearman's rank correlation.Results: 1 Plateau depression: Of the 33 cases, the depression was 2.80±1.26mm on plain radiographys and 5.46±1.87mm on spiral CT scans . The difference between them was statistically significant(p<0.05).2 Plateau widening: :Of the 33 cases, the widening was 3.13±1.35 mm on plain radiographys and 5.63±1.86 mm on spiral CT scans, There was significant difference (p<<0.05).3 Damage area of plateau:Of the 33 cases, there were 20 cases with damage area of plateau involving the weighting area of tibial plateau on plain radiographys, but there were 31 cases with that on the spiral CT-scans. The difference was significant. (p<0.05).4 Plateau smash: Of the 33 cases, there were more fragment showed on the spiral CT-scans than on plain X-ray film (p<0.05), The plateau smash was underestimated on plain radiographys.5 The knee function was not correlated with displacement, damage area and smash of the plateau on plain radiographys (p﹥0.05) .The evaluation on spiral CT scans showed that the knee function was significantly correlated with smash and the score of entire plateau(p<0.05) and not with displacement and damage area of plateau( p﹥0.05).6 The knee function score of 33 cases with tibial plateau fracture is 27.2±3.14 according to Rasmussen Knee Evaluation System. The function score of the contralateral knees is 30. There is significantly difference (p<0.05).Conclusions: 1 The measurement are more accurately and overall on spiral CT scans than on plain radiographys in estimating the tibial plateau fractures.2 In the tibial plateau fractures, the displacement,the damage area and the smash of the injuries of plateau are important parameters to assess the function of knee. The satisfactory quality of fracture reduction will lead to good function of the knee. 3 This study shows that the function of knee haven't totally recovered by following up for 18 months.
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