R Adams Cowley Shock Trauma Center, Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
J Orthop Trauma. 2012 Jul;26(7):422-6. doi: 10.1097/BOT.0b013e318228c1a1.
To evaluate the midterm functional outcomes of patients with isolated operatively treated patella fractures.
Prospective cohort and retrospective clinical and radiographic assessment.
A Level I and Level II trauma center.
PATIENTS/PARTICIPANTS: Two hundred forty-one patients underwent operative intervention for a displaced patella fracture between 1991 and 2007. After appropriate exclusions, 110 patients met criteria. A total of 40 (36%) patients with isolated, unilateral, operatively treated patella fractures with minimum 1-year follow-up agreed to participate in this study and return for functional testing. Mean follow-up was 6.5 years (range, 1.25-17 years).
Enrolled patients were treated with one of the following methods: standard tension band with Kirschner wires, tension band through 2 cannulated screws, longitudinal anterior banding with cerclage, or partial patellectomy.
All enrolled patients were evaluated with the SF-36 and an injury-specific questionnaire (Knee Injury and Osteoarthritis Outcome Scores) and asked to self-report symptomatic hardware. Patients were also evaluated by physical examination assessing range of motion and Biodex bilateral quadriceps isometric and isokinetic comparisons.
The mean normalized SF-36 physical composite score and the mean normalized Knee Injury and Osteoarthritis Outcome Scores subscale scores (pain, 71.7; symptoms, 66.3; activities of daily living, 75.1; sport/recreation, 45.2; quality of life, 49.6) were statistically different (P < 0.05) from reference population norms. Removal of symptomatic fixation was required in 52% of the patients treated with osteosynthesis, whereas 38% of those with retained fixation self-reported implant-related pain at least some of the time. Eight patients (20%) had an extensor lag greater than 5°. A restricted range of flexion of greater than 5° was noted in 15 patients (38%) and restricted range of extension of greater than 5° was noted in 6 patients (15%). Biodex dynamometric testing revealed a mean isometric extension deficit of 26% between the uninvolved and involved sides for peak torque. Extension power was also tested with an angular velocity of 90°/sec and 180°/sec and mean deficits of 31% and 29% were noted, respectively, when compared with the contralateral extremity.
At a mean of 6.5 years after operative treatment for patella fractures, significant symptomatic complaints and functional deficits persist based on validated outcome measures as well as objective physical evaluations. This study fills a void in the literature regarding the functional outcomes of these patients. It also underscores the complexity associated with treating this common fracture and should help guide surgeons to better counsel patients on the expected long-term function after operative treatment of patella fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估单纯手术治疗髌骨骨折患者的中期功能结局。
前瞻性队列和回顾性临床及影像学评估。
一级和二级创伤中心。
患者/参与者：1991 年至 2007 年间，241 例移位髌骨骨折患者接受手术干预。经过适当排除后，110 例符合标准。共有 40 名（36%）符合条件的、单侧、手术治疗的孤立性髌骨骨折患者，随访至少 1 年，同意参加本研究并返回进行功能测试。平均随访时间为 6.5 年（范围 1.25-17 年）。
纳入的患者接受以下方法之一治疗：标准张力带加克氏针、张力带经 2 个套管螺钉、前纵带环扎、或髌骨部分切除术。
所有纳入患者均采用 SF-36 和特定损伤问卷（膝关节损伤和骨关节炎结果评分）进行评估，并报告症状性内固定物。患者还通过评估运动范围和 Biodex 双侧股四头肌等长和等速比较的体格检查进行评估。
平均标准化 SF-36 躯体成分评分和平均标准化膝关节损伤和骨关节炎结果评分子量表评分（疼痛 71.7；症状 66.3；日常生活活动 75.1；运动/娱乐 45.2；生活质量 49.6）与参考人群正常值统计学差异显著（P < 0.05）。52%接受内固定治疗的患者需要取出有症状的固定物，而 38%保留固定物的患者至少有部分时间报告与植入物相关的疼痛。8 名患者（20%）存在伸膝延迟大于 5°。15 名患者（38%）存在屈曲受限大于 5°，6 名患者（15%）存在伸膝受限大于 5°。Biodex 动力测试显示，与健侧相比，患侧等长伸膝的峰值扭矩平均缺失 26%。还测试了以 90°/秒和 180°/秒的角速度进行的伸膝力量，分别记录到平均 31%和 29%的缺失，与对侧肢体相比。
在髌骨骨折手术后平均 6.5 年，根据验证后的结局测量和客观体格检查，仍存在明显的症状性抱怨和功能缺陷。本研究填补了关于这些患者功能结局的文献空白。它还强调了治疗这种常见骨折的复杂性，应该有助于指导外科医生更好地向患者提供关于髌骨骨折手术后预期长期功能的信息。
治疗性 IV 级。有关证据水平的完整描述，请参阅作者说明。
