Department of Traumatic Orthopedics, Ningbo No.6 Hospital, Ningbo, China.
Orthop Surg. 2022 Oct;14(10):2553-2562. doi: 10.1111/os.13450. Epub 2022 Sep 2.
Surgical treatment for Schatzker type II tibial plateau fractures remains challenging and requires high-quality research. The aim of the study is to compare the "windowing" and "open book" techniques for the treatment of Schatzker type II tibial plateau fractures.
In this prospective study, all patients with Schatzker type II tibial plateau fractures between January 2014 and December 2017 were managed by open reduction and internal fixation using an anterolateral incision approach. "Windowing" group included 78 patients (53 men and 25 women), with an average age of 57.7 ± 13.5 years, who underwent the "windowing" technique, in which the procedure was performed through a small cortical window against the depressed zone of the lateral plateau. The "open book" group included 80 patients (56 men and 24 women), with an average age of 54.8 ± 12.4 years, who underwent the technique. The clinical outcomes included the Rasmussen classification of knee function and grading of post-traumatic arthritis. The radiographic outcome (x-ray and computed tomography [CT]) was the reduction quality of the lateral plateau based on the modified Rasmussen radiological assessment. The patient-reported outcome was visual analogue scale (VAS) scores.
The mean follow-up time for the158 patients was 32 months (range, 24-42 months). The time elapsed from injury to surgery in "windowing" group and "open book" group were 3.7 ± 1.2 (range, 1-10 days) and 3.5 ± 1.4 days (range, 1-11 days), respectively, with no significant difference between the groups (P > 0.05). The operation times did not differ significantly between the "windowing" group (61.0 ± 8.3 min, range, 45-120 min) and the "open book" group (61.2 ± 10.4 min, range, 40-123 min) (P > 0.05). After surgery, CT revealed five (6.4%) and 15 (18.8%) cases of articular depression in the "windowing" and "open book" groups, respectively. Significant differences were observed in the articular depression of tibial plateau fractures between the groups (P < 0.05). However, condylar widening or valgus/varus did not differ significantly between the groups. Furthermore, no significant differences in knee function were observed during follow-up (P > 0.05). VAS scores were similar between the groups at 24 months after surgery (P > 0.05). There were significant differences in the number of severe post-traumatic arthritis (grades 2 and 3) cases between the groups (P < 0.05).
The "windowing" and "open book" techniques are both effective for the treatment of Schatzker type II tibial plateau fractures. However, the "windowing" technique provides better reduction quality, leading to a satisfactory prognosis.
对于 Schatzker II 型胫骨平台骨折的手术治疗仍然具有挑战性，需要高质量的研究。本研究旨在比较“开窗”和“开书”技术治疗 Schatzker II 型胫骨平台骨折的效果。
在这项前瞻性研究中，2014 年 1 月至 2017 年 12 月期间所有 Schatzker II 型胫骨平台骨折患者均采用前外侧入路切开复位内固定治疗。“开窗”组包括 78 例（男 53 例，女 25 例），平均年龄 57.7±13.5 岁，采用“开窗”技术，即通过外侧平台凹陷区的小皮质窗进行操作。“开书”组包括 80 例（男 56 例，女 24 例），平均年龄 54.8±12.4 岁，采用该技术。临床结果包括膝关节功能的 Rasmussen 分类和创伤后关节炎分级。影像学结果（X 线和 CT）为基于改良 Rasmussen 影像学评估的外侧平台复位质量。患者报告的结果是视觉模拟评分（VAS）。
158 例患者的平均随访时间为 32 个月（范围 24-42 个月）。“开窗”组和“开书”组的受伤至手术时间分别为 3.7±1.2（范围 1-10 天）和 3.5±1.4 天（范围 1-11 天），两组间无显著差异（P>0.05）。“开窗”组（61.0±8.3min，范围 45-120min）和“开书”组（61.2±10.4min，范围 40-123min）的手术时间无显著差异（P>0.05）。术后 CT 显示“开窗”组有 5 例（6.4%）和“开书”组有 15 例（18.8%）关节面凹陷。两组胫骨平台骨折关节面凹陷差异有统计学意义（P<0.05）。然而，髁间增宽或外翻/内翻在两组间无显著差异。此外，随访期间膝关节功能无显著差异（P>0.05）。术后 24 个月 VAS 评分两组间相似（P>0.05）。两组间严重创伤后关节炎（2 级和 3 级）病例数差异有统计学意义（P<0.05）。
“开窗”和“开书”技术治疗 Schatzker II 型胫骨平台骨折均有效，但“开窗”技术可提供更好的复位质量，从而获得满意的预后。
