2023, Vol. 27 ›› Issue (9): 1410-1416

Arthroscopy-assisted locking hollow screw fixation and open reduction plate internal fixation in the treatment of Schatzker II-III tibial plateau fractures: early CT evaluation

Zheng Bo, Zhang Xiuli, Zhou Hao, He Zebi, Zhou Jin, Zhou Weiyun, Li Peng   

Abstract: BACKGROUND: Schatzker II-III tibial plateau fractures are one of the most common fractures in clinical practice. The traditional open reduction and internal fixation scheme can cause great surgical trauma, often causing great troubles to clinicians and patients.
OBJECTIVE: To discuss the early imaging and clinical results of the treatment of Schatzker II-III tibial plateau fractures with arthroscopy-assisted locking hollow screws and traditional open reduction plate internal fixation.
METHODS:   118 patients with Schatzker II-III tibial plateau fractures who met the criteria for surgical treatment in Qingbaijiang District People’s Hospital of Chengdu from January 1, 2015 to January 1, 2020 were retrospectively collected and randomly assigned to two groups. The 52 cases of the locking hollow screw group were treated with locking hollow screw fixation assisted by arthroscopy. The 66 cases of the traditional group were treated with open reduction steel plate internal fixation. The intraoperative blood loss, incision length, cost, length of hospital stay, and visual analogue scale pain score before operation, 1 day and 1 week after operation were recorded and compared between the two groups. Before and 1 day after the operation, the knee joint was scanned by CT to record the maximum settlement distance of the tibial plateau articular surface. Range of motion, Hospital for Special Surgery knee score, Knee Society Score (clinical score and functional score), and complications during the last follow-up (2 years after surgery) were recorded.
RESULTS AND CONCLUSION: (1) The intraoperative blood loss, incision length, cost, and length of hospital stay were significantly better in the locking hollow screw group than those in the traditional group (P < 0.05). The surgical time in the traditional group was significantly shorter than that in the locking hollow screw group (P < 0.05). (2) There was no significant difference in visual analogue scale scores between the two groups before and 1 week after surgery (P > 0.05). At 1 day after surgery, the visual analogue scale score of the locking hollow screw group was significantly shorter than that of the traditional group (P < 0.05). (3) There was no significant difference in the fracture separation distance measured by CT before operation between the two groups (P > 0.05). At 1 day after operation, the fracture separation distance in the locking hollow screw group was significantly lower than that in the traditional group (P < 0.05). (4) At 2 years postoperatively, the range of flexion in the locking hollow screw group was significantly higher than that in the traditional group (P < 0.05). There was no significant difference in range of knee extension, hospital for special surgery knee score, and Knee Society Score (clinical score and functional score) between the two groups (P > 0.05). (5) It is indicated that compared with open reduction and internal fixation, arthroscopy-assisted locking hollow screw fixation in the treatment of Schatzker II-III tibial plateau fractures has advantages in blood loss, incision length, pain, cost, hospital stay, and degree of reduction. However, there was no significant difference in functional score and the operation time was longer.
Key words: arthroscopy, locking hollow screw, tibial plateau fracture, plate, internal fixation, clinical efficacy