双锚钉联合穿骨缝线固定髌骨下极粉碎骨折△（开放获取）

Double anchors combined with longitudinal transosseous sutures for comminuted patellar inferior pole fractures

摘要:

[目的]比较双锚钉联合纵向穿骨缝线与张力带钢丝联合环扎固定髌骨下极粉碎性骨折的临床疗效。[方法]回顾性分析 2021 年 2 月—2023 年 8 月在本院手术治疗的 41 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，20 例采用双锚钉联合纵向穿骨缝线 （缝合组），21 例采用张力带钢丝联合环扎固定 （张力带组）。比较两组围手术期、随访及影像资料。[结果]两组在手术时间、切口长度、术中出血量、住院时间等方面差异均无统计学意义（P＞0.05），但缝合组术中透视次数 [(2.6±0.6) 次 vs (4.7±1.1) 次, P＜0.001] 和术后 3 d VAS 评分 [(3.1±0.6) vs (4.8±0.7), P＜0.001] 均显著优于张力带组。平均随访时间 （14.6±1.9） 个月，两组骨折临床愈合时间差异无统计学意义 （P＞0.05）。随术后时间推移，两组膝 AKPS 评分、Bostman 评分及膝 ROM 显著改善 （P＜0.05）。缝合组术后 1 个月的 AKPS 评分 [(79.7±1.7) vs (73.7±1.7), P＜0.001]、Bostman 评分 [(22.6±1.4) vs (20.8±1.6), P=0.021]、膝 ROM [(92.0±7.2)° vs (85.7±6.3)°, P=0.006] 以及术后 3 个月 AKPS 评分 [(86.5±1.5) vs (84.5±2.5), P=0.004] 均显著优于张力带组，影像方面，与术前相比，术后两组关节面对合均显著改善 （P＜0.05），但是两组相应时间点的关节面对合、Insall-Salvati 指数及骨折影像愈合等方面差异均无统计学意义（P＞0.05）。[结论]双锚钉联合纵向穿骨缝线固定治疗髌骨下极粉碎性骨折临床疗效优于张力带钢丝联合环扎固定，且恢复快，并发症少，无需二次手术取出。

Abstract:

[Objective] To compare the clinical efficacy of double anchors combined with longitudinal transosseous sutures (DA-TOS) versus tension band combined with wire loop (TB-WL) for fixation of comminuted patellar inferior pole fractures. [Methods] A retrospective study was done on 41 patients who received surgical treatment for comminuted patellar inferior pole fractures in our hospital from February 2021 to August 2023. According to preoperative surgeon-patient discussion, 20 patients received DA-TOS, while other 21 patients underwent TB-WL. The perioperative, follow-up and imaging data of the two groups were compared. [Results] There were no significant differences in operation time, incision length, intraoperative blood loss and hospital stay between the two groups (P＞0.05). However, the DA-TOS group proved significantly superior to the TB-WL group in terms of number of intraoperative fluoroscopy [(2.6±0.6) vs (4.7±1.1), P＜0.001] and VAS score 3 days after surgery [(3.1±0.6) vs (4.8±0.7), P＜0.001]. The mean follow-up time was of (14.6±1.9) months, and there was no significant difference in clinical healing time between the two groups (P＞0.05). The AKPS score, Bostman score and knee ROM in both groups were significantly increased over time (P＜0.05). The DA-TOS group was significantly better than the TB-WL group in terms of AKPS score [(79.7±1.7) vs (73.7±1.7), P＜0.001], Bostman score [(22.6±1.4) vs (20.8±1.6), P=0.021], knee ROM [(92.0±7.2)° vs (85.7±6.3)°, P=0.006] 1 month after surgery, and AKPS score [(86.5±1.5) vs (84.5±2.5), P=0.004] 3 months postoperatively, whereas which were not significantly different between the two groups at the remaining time points (P＞0.05). As for imaging, the joint congruence in both groups improved significantly after operation (P＜0.05), but there were no significant differences regarding to joint congruence, Insall-Salvati index and fracture imaging healing between the two groups (P＞0.05). [Conclusion] Double anchors combined with longitudinal transosse-ous sutures take benefits of faster recovery, less complications and no need for a second operation to remove implant over the tension band combined with wire loop for fixation of comminuted patellar inferior pole fractures.