Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
Department of Rehabilitation, Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
J Orthop Sci. 2021 May;26(3):409-414. doi: 10.1016/j.jos.2020.04.001. Epub 2020 Apr 28.
Comminuted patellar fractures are not rare, and the ideal treatment method remains controversial. The present study was conducted to evaluate effects and compare complications of two different methods used to treat comminuted patellar fractures.
From March 2010 to August 2016, 102 cases of 34-C2 or 34-C3 comminuted patellar fractures were treated at our hospital, wherein patients received two different treatments: titanium cable tension band with cerclage method (group A) and intrafragmentary screws with X-shaped plating technique (group B). At follow-ups, articular step-off, range of motion (ROM), Lysholm scores, time of union, and complications were recorded and analyzed. Radiographic and clinical data as well as rate of complications were statistically analyzed.
In total, 87 patients were included in the final analysis (n = 47 in group A and n = 40 in group B). No significant differences were noted in terms of cost of implant, age, gender, rate of 34-C3 fractures, rate of layered inferior pole fractures, postoperative articular step-off and union time. At 2-year follow-up, average Lysholm scores, ROM and rate of complications were (89.0 ± 4.5), (122°±12°) and (27.7%) in group A and (90.2 ± 3.9), (124°±11°) and (17.5%) in group B, respectively, with no significant differences (p > 0.05). The mean time of surgery in group B was shorter than that in group A with significant difference (p < 0.05).
Treatment using the intrafragmentary screws and plate method for amenable comminuted patellar fractures achieved similar complication rate and favorable functional outcomes at the 2-year follow-up, which was comparable to the titanium cable tension band with cerclage method. Thus, the intrafragmentary screws and plate method is effective, safe and convenient for 34-C2/C3 comminuted patellar fractures, especially appropriate for patients with layered fragments.
粉碎性髌骨骨折并不少见，理想的治疗方法仍存在争议。本研究旨在评估两种不同方法治疗粉碎性髌骨骨折的效果并比较其并发症。
2010 年 3 月至 2016 年 8 月，我院收治 102 例 34-C2 或 34-C3 粉碎性髌骨骨折患者，分别采用钛缆张力带环扎（A 组）和骨折内固定螺钉 X 形钢板（B 组）两种不同方法治疗。随访时记录并分析关节台阶、活动度（ROM）、Lysholm 评分、愈合时间和并发症。对影像学和临床资料及并发症发生率进行统计学分析。
共 87 例患者最终纳入分析（A 组 47 例，B 组 40 例）。两组在植入物费用、年龄、性别、34-C3 骨折发生率、分层下极骨折发生率、术后关节台阶和愈合时间方面差异无统计学意义。在 2 年随访时，A 组 Lysholm 评分、ROM 和并发症发生率分别为（89.0±4.5）、（122°±12°）和（27.7%），B 组分别为（90.2±3.9）、（124°±11°）和（17.5%），差异均无统计学意义（p>0.05）。B 组手术时间短于 A 组，差异有统计学意义（p<0.05）。
对于可复位的粉碎性髌骨骨折，采用骨折内固定螺钉钢板法治疗，在 2 年随访时，其并发症发生率和功能结果与钛缆张力带环扎法相似。因此，骨折内固定螺钉钢板法对于 34-C2/C3 粉碎性髌骨骨折是有效、安全和方便的，尤其适用于分层骨折患者。
