Kim Kwang-Sub, Suh Dong-Whan, Park Sang-Eun, Ji Jong-Hun, Han Young-Hoon, Kim Jae-Hoon
Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64, Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
Arch Orthop Trauma Surg. 2021 Nov;141(11):1889-1897. doi: 10.1007/s00402-020-03671-5. Epub 2020 Oct 30.
Comminuted inferior pole fractures of the patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional tension band wiring. The purpose of this study is to evaluate the clinical and radiological outcomes of the suture bridge anchor fixation for these comminuted inferior pole fractures of the patella.
From March 2012 to December 2018, suture bridge anchor fixation for the inferior pole comminuted fracture of the patella was performed in 22 patients. There were 21 patients of inferior pole comminuted fracture and 1 patient of lower periosteal sleeve avulsion fracture. Clinical outcomes including SF-36 score, Knee injury and osteoarthritis outcome score (KOOS) and post-operative range of motion were evaluated. In all patients, suture bridge anchor fixation was performed and, tension band wiring with K wire was added for large fragment fixation in two patients. We evaluated bony union, the patellar height using Insall-Salvati ratio and its complications.
Mean age was 46 ± 20 (15-82) years. Mean follow-up period was 25 ± 18 (11-74) months. In all patients, bony union was achieved at postoperative 4 months. At final follow-up, mean SF-36 score was 72 ± 15 (30-91) points and KOOS score was 66.7 ± 16 (43-97). The average range of motion was 134 ± 5 (125-140) degrees. As a complication, one patient developed a wound infection and subsequent osteomyelitis of inferior pole fracture fragment. Compared to the normal knee, the Insall-Salvati ratio of the injured knee averages 0.73 and this smaller ratio less than 0.8 meant patella baja.
In the comminuted inferior pole fractures of the patella, suture bridge anchor fixation showed good bony union and satisfactory clinical outcomes at the short-term follow-up and could be a satisfactory alternative treatment option. Even though suture bridge anchor fixation in these fractures caused decreased Insall-Salvati ratio (patella height), any patellofemoral pain and limited range of motion was not developed.
Level IV.
髌骨下极粉碎性骨折是一种难治性骨折，采用传统张力带钢丝固定难以实现坚强内固定。本研究旨在评估缝线桥锚钉固定治疗髌骨下极粉碎性骨折的临床和影像学效果。
2012年3月至2018年12月，对22例患者实施了髌骨下极粉碎性骨折的缝线桥锚钉固定术。其中，下极粉碎性骨折患者21例，下极骨膜袖套撕脱骨折患者1例。评估临床效果，包括SF-36评分、膝关节损伤和骨关节炎疗效评分（KOOS）以及术后活动范围。所有患者均采用缝线桥锚钉固定，2例患者因骨折块较大，加用克氏针张力带钢丝固定。评估骨愈合情况、采用Insall-Salvati比值评估髌骨高度及其并发症。
平均年龄46±20（15-82）岁。平均随访时间25±18（11-74）个月。所有患者术后4个月均实现骨愈合。末次随访时，平均SF-36评分为72±15（30-91）分，KOOS评分为66.7±16（43-97）。平均活动范围为134±5（125-140）度。并发症方面，1例患者出现伤口感染，随后发生下极骨折块骨髓炎。与正常膝关节相比，患侧膝关节Insall-Salvati比值平均为0.73，该比值小于0.8意味着髌骨低位。
在髌骨下极粉碎性骨折中，缝线桥锚钉固定在短期随访中显示出良好的骨愈合和满意的临床效果，可能是一种令人满意的替代治疗选择。尽管这些骨折采用缝线桥锚钉固定导致Insall-Salvati比值（髌骨高度）降低，但未出现髌股疼痛和活动范围受限的情况。
四级。
