Department of Orthopaedic Trauma, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):1051-5. doi: 10.1097/TA.0b013e3182405296.
Surgical fixation of patella fractures is frequently indicated due to disruption of the quadriceps mechanism. Operative technique varies; however, failure rates can be high. The purpose of this study was to compare the effectiveness of various techniques for the fixation of patella fractures and the etiology of fixation failure.
We retrospectively reviewed 173 patella fractures treated operatively at two Level I trauma centers. Patients with less than 90 days of follow-up, inadequate radiographic studies, and partial or total excision were excluded. Failure was defined as hardware breakage, nonunion, or displacement of fragments from their initial reduced position. Twelve factors were examined independently for predictive value using both univariate and multivariate analyses. A comparison between groups based on reoperation and hardware removal was also performed.
One hundred nine patients met the inclusion criteria, and 13 were found to have failed (12%). Both older patient age (p < 0.02) and use of K-wires, with or without tension-band wires (p < 0.04), were found to be significant predictors of failure. Increasing follow-up time was the only significant predictor of reoperation (p < 0.001) and hardware removal (p < 0.001).
As anticipated, increasing age was found to correlate with higher failure rates. Use of K-wires with or without tension-band wires correlated with higher failure rates, compared with the use of screws, both K-wires and screws, or other fixation. Increasing follow-up time predicted both reoperation and hardware removal, with patients having symptomatic hardware and other complications naturally returning to clinic for evaluation and treatment.
由于股四头肌机制中断，常需要对髌骨骨折进行外科固定。手术技术多种多样，但失败率可能很高。本研究的目的是比较各种髌骨骨折固定技术的有效性以及固定失败的病因。
我们回顾性分析了在两个一级创伤中心接受手术治疗的 173 例髌骨骨折患者。排除随访时间少于 90 天、影像学研究不充分以及部分或完全切除的患者。失败定义为内固定物断裂、骨折不愈合或骨折块从初始复位位置移位。使用单变量和多变量分析分别对 12 个因素进行了独立的预测价值评估。还根据再次手术和内固定物去除情况对组间进行了比较。
109 例患者符合纳入标准，其中 13 例（12%）发生失败。患者年龄较大（p < 0.02）和使用克氏针（有或没有张力带钢丝）（p < 0.04）均被发现是失败的显著预测因素。随访时间的增加是再次手术（p < 0.001）和内固定物去除（p < 0.001）的唯一显著预测因素。
正如预期的那样，年龄的增加与更高的失败率相关。与使用螺钉、克氏针和螺钉联合使用或其他固定方法相比，使用克氏针联合或不联合张力带钢丝与更高的失败率相关。随访时间的增加预测了再次手术和内固定物去除，有症状的内固定物和其他并发症的患者自然会返回诊所进行评估和治疗。
