Shea Graham Ka-Hon, Hoi-Ting So Karen, Tam Kin-Wai, Yee Dennis King-Hang, Fang Christian, Leung Frankie
Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong.
School of Biomedical Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
Geriatr Orthop Surg Rehabil. 2019 Mar 5;10:2151459319827143. doi: 10.1177/2151459319827143. eCollection 2019.
Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques.
Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters.
Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods ( < .05).
Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism.
Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.
采用金属植入物固定治疗的髌骨骨折常导致局部软组织刺激，且需要取出植入物。另一种选择是使用基于缝线的固定方法。我们在髌骨骨折的常规治疗中采用了缝线和混合固定方法。在此，我们比较三种固定技术的结果。
在三年期间，87例符合条件的患者接受了髌骨骨折固定术。根据骨折形态，患者接受（1）缝线固定（经骨缝线和使用FiberWire的8字张力带）、（2）混合固定（经骨FiberWire缝线和金属张力带）或（3）金属固定。主要观察指标包括再次手术率和软组织刺激。次要观察指标包括手术并发症、影像学和功能参数。
金属固定的再次手术率最高（25/57，43.9%），缝线固定的再次手术率最低（2/13，15.4%）。因软组织刺激而需要取出植入物是再次手术的主要原因，且在缝线固定后明显较少见（1/13，7.7%，P<0.01）。与金属固定相比，混合固定导致的软组织刺激率（6/17，35.3%）和植入物取出率（7/17，41.2%）相似。与其他两种固定方法相比，混合固定后髌骨低位明显增加（13/17，76.5%），Insall-Salvati比值降低（0.742；95%置信区间：0.682 - 0.802）（P<0.05）。
缝线固定导致的软组织刺激最少，再次手术率最低，但添加金属张力带钢丝会抵消这些优势。混合固定也会使伸膝机制失衡。
应向患者告知其固定方法可能产生的后遗症。缝线固定是治疗髌骨远端极骨折的首选方法。额外的金属张力带环可能会提供额外的稳定性，但应用时应谨慎。
