新型接骨板技术治疗髌骨骨折的手术疗效：一项前瞻性队列研究。
Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study.
机构信息
*Orthopaedic Trauma Service, Hospital for Special Surgery and Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; †Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, NY; ‡Department of Physical Therapy, New York Presbyterian Hospital, New York, NY; and §Orthopaedic Trauma Service, Harborview Medical Center, Seattle, WA.
出版信息
J Orthop Trauma. 2017 May;31(5):241-247. doi: 10.1097/BOT.0000000000000787.
OBJECTIVE
The purpose of this prospective cohort study was to determine if a new patella fracture fixation construct resulted in improved outcomes compared with traditional tension band techniques.
DESIGN
Comparative cohort study.
SETTING
Academic level I trauma center.
PATIENTS/PARTICIPANTS: Patients with isolated, unilateral patellar fractures were enrolled prospectively. From 2012 to 2014, 33 patients underwent fixation with a novel plate construct that spans half of the patella circumference laterally and provides multiplanar fixation through a low-profile plate. A comparison cohort was drawn from 25 patients treated from 2008 to 2012, where treatment consisted of traditional tension band fixation techniques.
INTERVENTION
Surgical fixation of patella fractures was performed with either a tension band or novel plate construct.
MAIN OUTCOME MEASUREMENTS
Subjective postoperative clinical outcomes and objective functional and strength measurements were subsequently collected.
RESULTS
The 2 cohorts had similar baseline characteristics. Patients with the plate construct had clinically and statistically significantly superior Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) scores throughout the study period (P < 0.001). Functional testing also demonstrated significant improvements in patients with plate constructs compared with tension band constructs at 12 months. Patients in the plate cohort had significantly increased thigh circumferences (P = 0.003) and decreased anterior knee pain (P < 0.0001) compared with the tension band cohort.
CONCLUSIONS
In this prospective cohort study, the use of a novel fixation construct with multiplanar and interfragmentary fixation and minimal disruption of patellar vascularity enables improved clinical outcomes and functional performance.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
目的
本前瞻性队列研究旨在确定一种新的髌骨骨折固定结构是否比传统张力带技术的结果更好。
设计
比较队列研究。
地点
学术一级创伤中心。
患者/参与者：前瞻性纳入了孤立性单侧髌骨骨折患者。2012 年至 2014 年，33 名患者采用新型板固定结构进行固定，该结构横向跨越髌骨周长的一半，并通过低轮廓板提供多平面固定。从 2008 年至 2012 年治疗的 25 名患者中抽取了一个比较队列，治疗方法为传统张力带固定技术。
干预措施
采用张力带或新型板固定结构固定髌骨骨折。
主要观察指标
随后收集主观术后临床结果和客观功能及力量测量结果。
结果
两组患者的基线特征相似。在整个研究期间，使用板固定结构的患者的膝关节结局调查日常生活量表（KOS-ADLS）评分在临床和统计学上均明显优于张力带固定结构（P < 0.001）。功能测试还表明，与张力带固定结构相比，板固定结构的患者在 12 个月时功能显著改善。与张力带组相比，板组患者的大腿围明显增加（P = 0.003），且前膝疼痛明显减轻（P < 0.0001）。
结论
在这项前瞻性队列研究中，使用具有多平面和骨间固定以及对髌骨血供最小干扰的新型固定结构可改善临床结果和功能表现。
证据水平
治疗 II 级。请参阅作者说明，以获取完整的证据水平描述。
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