痛性Saupe III型二分髌骨空心钉固定与切除的比较△

Open reduction and cannulated screw fixation versus arthroscopic resection of painful Saupe type III bipartite patella

摘要:

[目的] 比较空心钉固定与切除治疗痛性 SaupeIII 型二分髌骨的临床疗效。[方法] 回顾性分析 2008 年 1 月—2020 年 1 月因二分髌骨就诊本院治疗的 19 例患者的临床资料，根据医患沟通结果，10 例行空心钉固定（固定组），9 例采用关节镜行副髌骨摘除 （切除组）。比较两组围手术期、随访及影像资料。[结果] 固定组的切口长度显著大于切除组 [(3.5±0.4) cm vs (1.8±0.3) cm , P＜0.05]，但前者在术后 5 d VAS 评分 [(2.6±0.2 ) vs (3.6±0.1), P＜0.05] 和下地行走时间 [(3.5±1.3) d vs (6.7±1.0) d, P＜ 0.05] 均显著优于后者（P＜0.05），两组切口愈合情况及住院时间的差异均无统计学意义（P＞0.05）。随访时间平均（36.1±2.5）个月，随时间推移，两组 VAS 评分显著减少 （P＜0.05），膝关节 Kujala 评分、Hungerford 评分、膝伸-屈 ROM 均显著增加 （P＜ 0.05）。术前两组间上述指标的差异均无统计学意义（P＞0.05），术后 12 个月，固定组在 VAS 评分 [(1.6±0.5) vs (2.9±0.8), P＜0.05]、 Kujala 评分 [(92.1±3.2) vs (85.8±4.4), P＜0.05]、Hungerford 评分 [(95.1±4.3) vs (87.5±5.4), P＜0.05] 及膝伸-屈 ROM [(139.4±4.7)° vs (131.6±3.3)° , P＜0.05] 均显著优于切除组（P＜0.05）。影像方面，与术前相比，术后 6、12 个月，两组髌股 K-L 评级和 Insall 指数均无显著变化（P＞0.05），相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 采用空心钉固定治疗痛性二分髌骨，具有创伤小、直视下复位和固定可靠的优点，近期临床结果优于镜下切除术。

Abstract:

[Objective] To compare the clinical efficacy of open reduction and cannulated screw fixation versus arthroscopic resection of painful Saupe type III bipartite patella. [Methods] A retrospective study was conducted on 19 patients who receive surgical treatment for painful bipartite patella in our hospital from January 2008 to January 2020. According to doctor-patient communication, 10 patients under- went open reduction and cannulated screw fixation (the fixation group), while the remaining 9 patients underwent arthroscopic resection (the resection group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although the fixation group had significantly longer incision than the resection group [(3.5±0.4) cm vs (1.8±0.3) cm, P＜0.05], the former proved significantly superior to the latter in terms of pain VAS score 5 days after operation [(2.6±0.2) vs (3.6±0.1), P＜0.05] and ambulation time [(3.5±1.3) days vs (6.7±1.0) days, P＜0.05], despite of insignificant differences in incision healing and hospital stay between the two groups (P＞0.05). With time of the fol- low-up lasted for (36.1±2.5) months on a mean, the pain VAS score significantly reduced (P＜0.05), whereas Kujala and Hungerford scores, as well as knee extension-flexion ROM significantly increased in both groups (P＜0.05). There were no statistically significant differences in the above indexes between the two groups before operation (P＞0.05), but the fixation group was significantly better than the resection group in terms of VAS score [(1.6±0.5) vs (2.9±0.8), P＜0.05], Kujala score [(92.1±3.2) vs (85.8±4.4), P＜0.05], Hungerford score (95.1±4.3) vs (87.5± 5.4), P＜0.05] and knee ROM [(139.4± 4.7)° vs (131.6± 3.3)°, P＜0.05] 12 months postoperatively. Regarding to imaging, the patello- femoral K-L classification and Insall index remained unchanged significantly in both groups at 6 and 12 months after surgery compared with those preoperatively (P＞0.05), which were not statistically significant between the two groups at any time points correspondingly (P＞0.05). [Conclusion] The open reduction and cannulated screw fixation take the advantages of less trauma, direct vision reduction and reliable fixa- tion, do achieve better clinical outcome over the arthroscopic resection for painful bipartite patella.