Department of Orthopaedic Surgery, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, China.
Department of Orthopaedic Surgery, Hangzhou Cancer Hospital, Hangzhou, China.
Orthop Surg. 2021 Apr;13(2):651-658. doi: 10.1111/os.12876. Epub 2021 Feb 22.
To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42-59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight-bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90°pain-free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft-tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52-63 min). The average blood loss was 59.8 mL (range: 45-71 mL). For all patients, pain-free 90° range of motion was restored in 2-4 weeks, and the full range of motion was restored in 8-11 weeks. All patients achieved bone union in 6-9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft-tissue irritation. The modified Cincinnati score at 12-month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella.
目的 本研究旨在介绍一种治疗髌骨下极骨折的新型固定技术。我们对 2018 年 1 月至 2019 年 6 月在我院治疗的髌骨下极骨折连续病例进行了前瞻性观察研究。患者包括 3 名男性和 1 名女性，平均年龄 47 岁（范围：42-59 岁）。所有患者均采用新型边缘钢板固定技术治疗，以保留髌骨下极。术中，将 2.4mm 直锁定加压钢板塑形为与髌骨下半弧形相适应的边缘钢板。骨折复位后，通过多个锁定螺钉将边缘钢板固定在髌骨近端，持续牵拉髌腱。边缘钢板环绕并压缩下极骨折块，起到加压和阻挡作用。如有必要，可加用前侧张力带或微型锁定钢板进一步防止下极骨折块向前移位。在这种刚性固定下，术后鼓励膝关节活动和完全负重。患者每月随访一次，直至术后 12 个月。记录达到无痛、膝关节完全活动范围和骨折愈合的时间。监测相关并发症，包括感染、复位丢失、固定失败、前膝疼痛和软组织刺激。采用改良 Cincinnati 膝关节评分系统评估膝关节功能。平均手术时间为 58.8 分钟（范围：52-63 分钟）。平均失血量为 59.8 毫升（范围：45-71 毫升）。所有患者在 2-4 周内恢复无痛 90°活动范围，8-11 周内恢复完全活动范围。所有患者均在 6-9 周内实现骨愈合，无骨折块移位或植入物断裂。无患者诉前膝疼痛或软组织刺激。12 个月随访时，改良 Cincinnati 评分显示 4 例患者均取得良好疗效。边缘钢板技术可能是治疗髌骨下极骨折的一种可行选择。
