Kadar Assaf, Sherman Haggai, Drexler Michael, Katz Eldad, Steinberg Ely L
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.
Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Int Orthop. 2016 Jan;40(1):149-54. doi: 10.1007/s00264-015-2776-9. Epub 2015 Apr 26.
Partial patellectomy (PP) and reattachment of the patellar ligament with transosseous suturing is the mainstay of surgical treatment for distal pole patellar fractures. An anchor suturing (AS) technique has recently been reported as an alternative to PP in such fractures and allows for bone-to-bone interface and possibly superior fracture healing than bone-to-tendon interface with PP. We present our experience with AS and compare it to PP.
Between 2006 and 2011, 60 patients with distal pole patellar fracture underwent either AS (n = 27) or PP (n = 33). We retrospectively gathered their demographic data and information on fracture type, fixation technique, operation time, postoperative complications and knee range of motion. A telephone survey was performed to grade functional outcomes with standard questionnaires (the SF-12 for quality of life, the Kujala score for patellofemoral function and a visual analog scale [VAS] pain score).
AS was equivalent to PP in terms of residual pain and functional outcomes (VAS: 2.45 vs. 2.26, p = 0.83 and Kujala score: 74.3 vs. 69, p = 0.351, respectively) as well as for knee range of motion. Complications included three cases of infection in each group, two cases of early hardware failure and one case of non-union in the AS group. Operation time was significantly shorter for AS compared to PP (68.5 vs. 79.1 min, p = 0.03).
AS is non-inferior to PP for function and pain after distal pole patellar fractures and is superior to PP with regard to operative time. Common complications of this technique are hardware failure and infections.
Therapeutic Level III.
部分髌骨切除术（PP）及经骨缝合髌韧带再附着术是治疗髌骨远端骨折的主要手术方式。最近有报道称锚钉缝合（AS）技术可作为此类骨折PP手术的替代方法，该技术可实现骨与骨的界面连接，可能比PP的骨与肌腱界面具有更好的骨折愈合效果。我们介绍了我们应用AS技术的经验，并将其与PP技术进行比较。
2006年至2011年期间，60例髌骨远端骨折患者接受了AS手术（n = 27）或PP手术（n = 33）。我们回顾性收集了他们的人口统计学数据以及骨折类型、固定技术、手术时间、术后并发症和膝关节活动范围等信息。通过电话调查，使用标准问卷（用于生活质量的SF - 12、用于髌股关节功能的Kujala评分和视觉模拟量表[VAS]疼痛评分）对功能结果进行评分。
在残留疼痛和功能结果方面（VAS评分：2.45对2.26，p = 0.83；Kujala评分：74.3对69，p = 0.351）以及膝关节活动范围方面，AS与PP相当。并发症包括每组3例感染、AS组2例早期内固定失败和1例骨不连。与PP相比，AS的手术时间明显更短（68.5对79.1分钟，p = 0.03）。
对于髌骨远端骨折后的功能和疼痛，AS不劣于PP，且在手术时间方面优于PP。该技术的常见并发症是内固定失败和感染。
治疗性III级。
