Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
Injury. 2020 Aug;51 Suppl 3:S50-S55. doi: 10.1016/j.injury.2020.01.012. Epub 2020 Jan 9.
This prospective study aims to describe our experience in the management of transverse patellar fractures in elderly patients with minimally invasive osteosynthesis technique (MIOT), at 12-months follow-up.
Patients older than 60, with transverse patellar fracture, type 34-C1 according to the AO/OTA classification system, referred to our trauma centre, between January 2014 and December 2017 were prospectively recruited. All the patients were managed using MIOT surgical procedure and underwent a clinical and radiological follow-up at 2 weeks, 6 weeks and at 3, 6, 12 and 15 months postoperatively. The clinical evaluation was performed using the Lysholm Knee Scoring System (LKSS) and the Visual Analogue Scale (VAS) for pain. The hardware removal was planned at 12-months follow-up. The paired t-test was performed. The test was two-tailed with a confidence level of 5%.
61 patients were recruited. The mean VAS was significantly lower in MIOT group until the 3-months follow-up (p = 0.001). ROM in flexion and LKSS score were significantly better in MIOT-group at all follow-ups, whereas ROM in extension showed no differences, between the two groups, starting from the 6-months follow-up. In the open surgery group, a significantly higher rate of delayed wound healing (p = 0.014), broken wires (p = 0.001) and non-cosmetic scar (p = 0.0221) was observed.
This prospective study shows that MIOT is a safe option for treatment of patellar transverse fractures in elderly patients, since it reduces the intra-operative blood loss, shortens the operating time, and is endowed with lower rates of postoperative complications.
本前瞻性研究旨在描述我们在微创接骨术（MIOT）治疗老年患者横断髌骨骨折方面的经验，随访时间为 12 个月。
2014 年 1 月至 2017 年 12 月，前瞻性招募年龄大于 60 岁、AO/OTA 分类系统为 34-C1 型的横断髌骨骨折患者。所有患者均采用 MIOT 手术治疗，并在术后 2 周、6 周及 3、6、12、15 个月进行临床和影像学随访。临床评估采用 Lysholm 膝关节评分系统（LKSS）和视觉模拟评分（VAS）进行疼痛评估。计划在 12 个月随访时去除内固定物。采用配对 t 检验。检验为双侧，置信水平为 5%。
共招募 61 例患者。MIOT 组的 VAS 评分在随访 3 个月时显著降低（p=0.001）。MIOT 组在所有随访中膝关节活动度和 LKSS 评分均显著更好，而在 6 个月随访时，两组间膝关节活动度在伸展时无差异。在开放手术组中，延迟伤口愈合（p=0.014）、断丝（p=0.001）和非美容性瘢痕（p=0.0221）的发生率明显较高。
本前瞻性研究表明，MIOT 是治疗老年髌骨横断骨折的一种安全选择，因为它可以减少术中失血量，缩短手术时间，降低术后并发症发生率。
