老年患者的髌骨骨折：一项基于多中心 CT 的分析。
Patellar fractures in elderly patients: a multicenter computed tomography-based analysis.
机构信息
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
出版信息
Arch Orthop Trauma Surg. 2021 Sep;141(9):1439-1445. doi: 10.1007/s00402-020-03526-z. Epub 2020 Jul 24.
INTRODUCTION
This study aimed to demonstrate the characteristics of patellar fractures and evaluate clinical outcomes in elderly patients.
PATIENTS AND METHODS
Medical records of patients aged ≥ 60 years who presented with patellar fractures were retrospectively reviewed from an institutionally approved multicenter (five institutions) orthopedic database. Patient characteristics and fracture patterns were identified, and the clinical outcomes were investigated. We compared differences according to the injury mechanism (low- vs. high-energy).
RESULTS
A total of 202 patients [mean age, 69.4 years (range, 60-88 years); male, 89, female, 113] were included in this study. The mean follow-up period was 14.8 months (range 6-58 months), and 75% of the fractures were from low-energy injuries. According to the AO /OTA classification, the most common type was type C (136 cases, 67.3%; 33 cases, C1; 23, C2; and 80, C3), followed by type A (39 cases), type B (26 cases), and unclassified (1 case). The unclassified case was an intra-articular marginal impaction without cortical breakage. Computed tomography (CT) revealed that of the cases, 66.8% had an inferior pole involvement; 80.7%, a comminuted fragment; and 10.4%, an impacted fracture. A total of 166 fractures (82.2%) were treated surgically. The mean union time and range of motion were 13.1 weeks and 123.8° (range 30-150°), respectively. The Lysholm score was 82.1 ± 12.0, with 65.7% of the cases having excellent or good function. The complication rate was 12.4% (24 cases), including ten, four, two, and five cases of infection, fixation failure, nonunion, malunion, and pin migration, respectively. The reoperation rate was 26.4%.
CONCLUSION
Patellar fractures in the elderly were mostly from low-energy injuries, and types C3 and A1 were the most common. CT images demonstrated high rates of an inferior pole involvement and comminution. The complication and reoperation rates were relatively high.
简介
本研究旨在展示老年髌骨骨折患者的特征，并评估其临床疗效。
患者与方法
从机构批准的多中心（五家机构）骨科数据库中回顾性分析了年龄≥60 岁、存在髌骨骨折的患者的病历。确定了患者特征和骨折模式，并对临床结果进行了调查。我们根据损伤机制（低能与高能）比较了差异。
结果
共纳入 202 例患者[平均年龄 69.4 岁（范围 60-88 岁）；男 89 例，女 113 例]。平均随访时间为 14.8 个月（范围 6-58 个月），75%的骨折为低能损伤所致。根据 AO/OTA 分类，最常见的类型是 C 型（136 例，67.3%；33 例 C1，23 例 C2，80 例 C3），其次是 A 型（39 例）、B 型（26 例）和未分类（1 例）。未分类的病例为关节内边缘嵌压，无皮质骨折。CT 显示，66.8%的病例累及髌骨下极；80.7%的病例存在粉碎性骨折；10.4%的病例为嵌插骨折。共有 166 例（82.2%）骨折患者接受了手术治疗。平均愈合时间和活动范围分别为 13.1 周和 123.8°（范围 30-150°）。Lysholm 评分为 82.1±12.0，65.7%的病例功能优良。并发症发生率为 12.4%（24 例），包括感染 10 例、固定失败 4 例、骨不连 2 例、畸形愈合 5 例和钢针迁移 5 例。再手术率为 26.4%。
结论
老年人髌骨骨折多由低能损伤引起，C3 型和 A1 型最为常见。CT 图像显示，髌骨下极受累和粉碎性骨折的发生率较高。并发症和再手术率相对较高。
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