髌骨下极粉碎性骨折两种内固定的比较（开放获取）

Comparison of two internal fixation techniques for comminuted fractures of the patellar inferior pole (OA)

摘要:

[目的] 比较缝线联合固定与钢丝联合固定髌骨下极粉碎性骨折的临床疗效。[方法] 回顾性分析 2019 年 1 月— 2021 年 12 月本院手术治疗的 52 例髌骨下极粉碎性骨折患者的临床资料。依据术前医患沟通结果，28 例采用缝线联合固定 （缝线组），24 例采用钢丝联合固定 （钢丝组）。比较两组围手术期、随访和影像结果。[结果] 所有患者均顺利完成手术，术中均无严重并发症发生。两组切口总长度、术中失血量、切口愈合等级差异无统计学意义 （P＞0.05），但是，缝线组在手术时间 [(60.7±7.8) mim vs (67.0±8.8) min, P=0.009]、术中透视次数 [(2.2±0.5) 次 vs (4.3±0.8) 次, P＜0.001]、术后 5 d 疼痛 VAS 评分 [(4.5± 0.9) vs (5.5±0.8), P＜0.001]、下地行走时间 [(2.2±0.6) d vs (3.0±0.7) d, P＜0.001]、住院时间 [(7.9±0.9) d vs (8.6±1.3) d, P=0.015] 均显著优于钢丝组。随访时间平均（18.3±3.8）个月，缝线组恢复完全负重活动时间显著早于钢丝组 [(10.9±3.1) 周 vs (12.7±2.5) 周, P= 0.031]。随着时间推移，两组患者膝前痛 VAS 评分、膝 ROM、Bostman 评分、Kujala 评分均显著改善（P＜0.05），术后 3 个月和末次随访时两组 Bostman 评分差异无统计学意义 （P＞0.05），其余相应时间点，缝线组上述指标均显著优于钢丝组 （P＜0.05）。 影像方面，随着时间推移，两组 Insall-Salvati 指数、髌骨长度无显著改变 （P＞0.05）；相应时间点，缝线组 Insall-Salvati 指数显著小于钢丝组 （P＜0.05），而髌骨长度显著大于钢丝组 （P＜0.05）。缝线组影像学骨折愈合时间显著早于钢丝组 （P＜0.05）。 [结论] 缝线垂直间断 NICE 结固定联合带线锚钉治疗髌骨下极粉碎性骨折临床疗效优于钢丝联合固定，且手术时间短，恢复快，并发症少，无需二次手术取出。

Abstract:

[Objective] To compare the clinical efficacy of suture combined fixation versus steel wire combined fixation for comminuted fractures of the patellar inferior pole. [Methods] A retrospective study was done on 52 patients who received surgical treatment for comminuted fractures of the patellar inferior pole in our hospital from January 2019 to December 2021. According to preoperative surgeon-patient discussion, 28 patients were treated with suture combined fixation (the suture group), while other 24 patients underwent steel wire combined fixation (the wire group). The perioperative, follow-up and imaging documemts were compared between the two groups. [Results] All patients had corresponding surgical procedures performed successfully, with no serious complications occurred during the operation. Although there were no significant differences in the total incision length, intraoperative blood loss and incision healing grade between the two groups (P＞0.05), the suture group proved significantly superior to the wire group in terms of operation time [(60.7±7.8) mim vs (67.0±8.8) min, P=0.009], intraoperative fluoroscopy times [(2.2±0.5) times vs (4.3±0.8) times, P＜0.001], pain VAS score 5 days postoperatively [(4.5± 0.9) vs (5.5±0.8), P＜0.001], postoperative walking time [(2.2±0.6) days vs (3.0±0.7) days, P＜0.001] and hospital stay [(7.9±0.9) days vs (8.6± 1.3) days, P=0.015]. The follow-up period lasted for (18.3±3.8) months in a mean, and the suture group resumed full weight-bearing activity significantly earlier than the wire group [(10.9±3.1) weeks vs (12.7±2.5) weeks, P=0.031]. The VAS score for anterior knee pain, knee range of motion (ROM), Bostman and Kujala scores significantly improved in both groups over time (P＜0.05), which in the suture group were significantly superior to those in the wire group (P＜0.05), except Bostman score between two groups at 3 months after surgery and the latest follow-up (P＞0.05). As for imaging, there were no significant changes in Insall-Salvati index and patella length in both groups over time (P＞0.05). At all corresponding time points, the suture group had significantly less Insall-Salvati index (P＜0.05), while significantly greater patellar length than the wire group (P＜0.05), additionally, the former got fracture healing significantly earlier than the latter (P＜ 0.05). [Conclusion] The vertical interrupt sutures with Nice knot fixation combined with suture anchor takes benefits of shorter operation time, faster recovery, less complications and no need for a second operation to remove implant over the steel wire counterpart for fixation of comminuted fractures of the patellar inferior pole.