镜下与开放钛缆固定髌骨骨折比较△（开放获取）

(Open Access) Arthroscopic reduction and titanium cable fixation versus open counterpart for patellar fractures

摘要:

[目的] 比较关节镜下与传统开放复位钛缆内固定治疗髌骨骨折的临床疗效。[方法] 回顾性分析2022 年1 月—2022 年12 月本科收治的闭合性单侧髌骨骨折59 例患者的临床资料。根据医患沟通结果，31 例采用镜下钛缆内固定（镜下组），28 例采用开放复位内固定（开放组）。比较两组围手术期、随访及影像资料。[结果] 所有患者均顺利完成手术，镜下组切口总长度[(3.5±0.3) cm vs (8.5±0.6) cm, P＜0.001]、术中失血量[(73.5±16.4) ml vs (94.6±21.5) ml, P＜0.001]、术中透视次数[(2.8±0.9) 次vs (3.4±1.0) 次, P=0.035]、住院时间[(4.3±1.5) d vs (8.3±2.1) d, P＜0.001] 均显著优于开放组。随访时间平均（15.3±4.4） 个月，两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。术后随时间推移，两组患者VAS 评分、Kujala 评分、Lysholm 评分、膝伸-屈ROM 均显著改善（P＜0.05）。术后12 周和末次随访时，镜下组的膝伸-屈ROM [(105.0±3.9)° vs (100.5±3.9)°, P＜0.001；(117.9±4.8)° vs (112.3±4.4)°, P＜0.001] 显著优于开放组。影像方面，与术前相比，末次随访时两组关节面对合均显著改善（P＜0.05），相应时间点，两组间关节面对合情况的差异均无统计学意义（P＞0.05）。两组影像骨折愈合时间的差异均无统计学意义（P＞0.05）。[结论] 与开放复位内固定相比，关节镜下髌骨骨折复位，钛缆内固定具有安全性好、出血量小、手术时间短、切口小、住院时间短、功能恢复更好的优点。

Abstract:

[Objective] To compare the clinical efficacy of arthroscopic reduction and titanium cable internal fixation versus traditionalopen counterpart for patellar fractures. [Methods] A retrospective study was conducted on 59 patients had closed unilateral patellar frac-tures treated surgically in our department from January 2022 to December 2022. According to doctor-patient communication, 31 patients un-derwent arthroscopic reduction and titanium cable internal fixation (the arthroscopic group), while other 28 patients received open reductionand titanium cable internal fixation (the open group). The perioperative, follow-up and imaging data of the two groups were compared. [Re-sults] All the patients in both groups were successfully operated on. The arthroscopic group proved significantly superior to the open group interms of total incision length [(3.5±0.3) cm vs (8.5±0.6) cm, P＜0.001], intraoperative blood loss [(73.5±16.4) ml vs (94.6±21.5) ml, P＜0.001],intraoperative fluoroscopy times [(2.8±0.9) times vs (3.4±1.0) times, P=0.035], hospital stay [(4.3±1.5) day vs (8.3±2.1) days, P＜0.001]. Themean follow-up period was of (15.3±4.4) months, and there was no significant difference in time to resume full weight-bearing activities be-tween the two groups (P＞0.05). The VAS, Kujala and Lysholm scores, as well as knee extension-flexion range of motion (ROM) were signifi-cantly improved in both groups over time postoperatively (P＜0.05). At 12 weeks and the last follow-up, the arthroscopic group was signifi-cantly better than the open group in terms of knee extension-flexion ROM [(105.0±3.9)° vs (100.5±3.9)°, P＜0.001; (117.9±4.8)° vs (112.3±4.4)°, P＜0.001]. Regarding to imaging, the joint surface congruity was significantly improved in both groups at the last follow-up comparedwith that preoperatively (P＜0.05). However, there were no statistically significant differences in the joint face congruity between the twogroups at and corresponding time points (P＞0.05), and fracture healing time between the two groups (P＞0.05). [Conclusion] The arthroscop-ic reduction and titanium cable internal fixation for patellar fractures has the advantages of better safety, less bleeding, shorter operation time, smaller incision, shorter hospital stay and better functional recovery over the open counterpart.