回顾性队列研究粉碎性髌骨骨折术后并发症的发生率：克氏针、空心螺钉、环形钉张力带固定的比较。
A retrospective cohort study on prevalence of postoperative complications in comminuted patellar fractures: comparisons among stabilized with Cannulated-Screw, Kirschner-Wire, or Ring-Pin Tension Bands.
机构信息
Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China.
出版信息
BMC Musculoskelet Disord. 2021 Jan 11;22(1):60. doi: 10.1186/s12891-020-03936-5.
BACKGROUND
Displaced patellar fractures are commonly treated with open reduction and fixation with several different types of tension-band (TB) constructs. The main objective of this study was to compare the prevalence of postoperative complications after surgical stabilization of comminuted patellar fractures with either a modified Kirschner-wire tension band (MKTB), a cannulated-screw tension band (CSTB), or a ring-pin tension band (RPTB).
METHODS
We conducted a retrospective and consecutive cohort study of comminuted patellar fractures (n = 334) stabilized using a TB construct. Postoperative premature loss of reduction, infection, and skin breakdown were compared according to the type of TB constructs received (MKTB, CSTB, or RPTB). The rate of implant removal due to symptomatic hardware was also evaluated.
RESULTS
Fixation failure rate was significantly different among the groups (P = 0.013), with failure rates of 4.7% observed in the MKTB group,14.5% in the CSTB group, and 4.9% in the RPTB group. Skin breakdown and infection were not significantly different among the groups (Ps > 0.05). Due to symptomatic hardware, 40.5% of the patients in the MKTB group, 22.9% in the CSTB group, and 24.3% in the RPTB group underwent implant removal (P = 0.004). After adjusting for age, gender, comorbidities, number of supplementary screws/K-wires, and use of cerclage cables, multivariate regression analysis revealed that CSTB contributed to a 2.08-times greater risk of fixation failure compared to RPTB, while MKTB and RPTB were similar in risk of failure. In addition, it was found that patients who underwent MKTB fixation were more than twice as likely to undergo implant removal for symptomatic hardware compared with RPTB (odds ratio = 2.11, 95% CI = 1.20 to 3.72; P = 0.010).
CONCLUSIONS
RPTB have advantage over MKTB and CSTB fixation in terms of symptomatic hardware and premature failure, respectively.
LEVEL OF EVIDENCE
Therapeutic Level III.
背景
移位髌骨骨折通常采用切开复位和多种张力带（TB）固定治疗。本研究的主要目的是比较改良克氏针张力带（MKTB）、空心螺钉张力带（CSTB）和环钉张力带（RPTB）固定粉碎性髌骨骨折术后并发症的发生率。
方法
我们对 334 例采用 TB 固定的粉碎性髌骨骨折患者进行了回顾性连续队列研究。根据 TB 固定的类型（MKTB、CSTB 或 RPTB）比较术后早期复位丢失、感染和皮肤破裂的发生率。还评估了因症状性内固定取出的植入物去除率。
结果
各组固定失败率差异有统计学意义（P = 0.013），MKTB 组失败率为 4.7%，CSTB 组为 14.5%，RPTB 组为 4.9%。各组皮肤破裂和感染差异无统计学意义（P > 0.05）。由于症状性内固定，MKTB 组 40.5%、CSTB 组 22.9%、RPTB 组 24.3%的患者接受了植入物取出（P = 0.004）。在校正年龄、性别、合并症、附加螺钉/克氏针数量和使用环形电缆后，多变量回归分析显示 CSTB 与 RPTB 相比，固定失败的风险增加 2.08 倍，而 MKTB 和 RPTB 的失败风险相似。此外，还发现与 RPTB 相比，MKTB 固定的患者因症状性内固定而接受植入物去除的可能性是 RPTB 的两倍多（比值比=2.11，95%置信区间=1.20 至 3.72；P = 0.010）。
结论
RPTB 在症状性内固定和早期失败方面分别优于 MKTB 和 CSTB 固定。
证据水平
治疗 III 级。
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