Kaiser Permanente South Bay Medical Center, Harbor City, California 90710, USA.
J Bone Joint Surg Am. 2013 Apr 3;95(7):653-9. doi: 10.2106/JBJS.K.01549.
Displaced patellar fractures are commonly stabilized with a modified anterior tension-band construct. The goal of the current study was to compare the incidence of complications after tension-band fixation of the patella with Kirschner wires as compared with cannulated screws.
We performed a retrospective cohort study of consecutive, surgically treated patellar fractures. Patients were divided into two cohorts: fractures fixed with use of Kirschner wires and fractures fixed with use of cannulated screws. The primary outcome measure was early loss of fixation that necessitated revision surgery. Secondary outcomes included early postoperative infection and the need for implant removal.
Four hundred and forty-eight patellar fractures were studied. Kirschner wires were used for fixation in 315 (70%), and cannulated screws were used for fixation in 133 (30%). The incidence of fixation failure was 3.5% in the Kirschner-wire group and 7.5% in the screw group (p = 0.065). A postoperative infection occurred in 4.4% of patients in the Kirschner-wire group and 1.5% of patients in the screw group (p = 0.17). One hundred sixteen (37%) patients in the Kirschner-wire group and 30 (23%) in the screw group underwent elective implant removal (p = 0.003). After adjusting for confounding variables, a trend toward increased incidence of fixation failure with screws as compared with Kirschner wires was present (p = 0.083). Patients treated with Kirschner wires were twice as likely to undergo implant removal compared with those treated with screws (p = 0.002).
Serious complications are uncommon following treatment of patellar fractures with a modified tension-band technique, with use of either Kirschner wires or cannulated screws. In both groups the rate of fixation failure was low, as was the rate of postoperative infection. Symptomatic implants, the most common complication observed, were twice as frequent in patients treated with Kirschner wires.
移位髌骨骨折通常采用改良的前张力带固定。本研究的目的是比较克氏针与空心螺钉固定髌骨张力带后的并发症发生率。
我们对连续手术治疗的髌骨骨折患者进行了回顾性队列研究。患者分为两组：使用克氏针固定的骨折和使用空心螺钉固定的骨折。主要观察指标为早期固定丢失，需要再次手术。次要结果包括早期术后感染和需要取出植入物。
共研究了 448 例髌骨骨折。315 例（70%）采用克氏针固定，133 例（30%）采用空心螺钉固定。克氏针组固定失败发生率为 3.5%，螺钉组为 7.5%（p=0.065）。克氏针组术后感染发生率为 4.4%，螺钉组为 1.5%（p=0.17）。克氏针组 116 例（37%）和螺钉组 30 例（23%）患者行择期取出植入物（p=0.003）。调整混杂变量后，螺钉组固定失败的发生率较克氏针组有增加趋势（p=0.083）。与使用螺钉治疗的患者相比，使用克氏针治疗的患者更有可能进行植入物去除（p=0.002）。
采用改良张力带技术治疗髌骨骨折，使用克氏针或空心螺钉均少见严重并发症。两组固定失败率和术后感染率均较低。最常见的并发症是症状性植入物，使用克氏针治疗的患者发生率是使用螺钉治疗的患者的两倍。
