Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea; Department of Orthopedic Surgery, Cheju Halla Hospital, Jeju, Korea.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
J Arthroplasty. 2021 Aug;36(8):2986-2991. doi: 10.1016/j.arth.2021.03.053. Epub 2021 Apr 3.
To the best of our knowledge, there have been no large case studies on patellar fracture after total knee arthroplasty (TKA) with patella retention.
From 2005 to 2019, 2954 consecutive TKAs with patella retention were retrospectively reviewed. The incidence of patellar fracture was confirmed. Perioperative demographic factors associated with patellar fracture were compared between the nonpatellar fracture control (randomly selected after age and sex matching) and patellar fracture patient groups. To confirm the prognosis of identified patellar fractures, Hospital for Special Surgery knee score, union rates, and complications after treatment were evaluated. Treatment outcomes were compared as per the treatment method, and fracture type was classified by shape.
For primary TKAs with patella retention, patellar fracture occurred in 32 of 2883 cases (incidence 1.11%). When comparing the preoperative demographic factors between the patellar fracture and control groups, there was a significant difference in knee flexion of the affected limb. Twenty-three cases were treated nonoperatively, and nine cases were treated operatively. Of the 32 patellar fractures, 28 had confirmed union, and the HSS score at the latest follow-up increased significantly from the preoperative score. The only complication noted after treatment was nonunion in three cases. We found no significant differences in treatment results as per the treatment method and fracture type.
Patellar fracture after TKA with retained patella is infrequent, with relatively improved clinicoradiological results over those of patellar fracture after TKA with resurfaced patella reported in the literature. The improved results did not differ as per the treatment method and fracture type.
据我们所知，目前还没有关于保留髌骨的全膝关节置换术后髌骨骨折的大型病例研究。
回顾性分析了 2005 年至 2019 年 2954 例连续接受保留髌骨的全膝关节置换术患者的临床资料。确认髌骨骨折的发生率。比较髌骨骨折患者与非髌骨骨折对照组（按年龄和性别匹配后随机选择）围手术期与髌骨骨折相关的人口统计学因素。为了明确髌骨骨折的预后，评估了骨科膝关节评分（HSS）、愈合率和治疗后并发症。根据治疗方法比较治疗效果，并根据骨折形状对骨折类型进行分类。
对于保留髌骨的初次全膝关节置换术，2883 例中有 32 例（发生率 1.11%）发生髌骨骨折。比较髌骨骨折组和对照组的术前人口统计学因素，发现患侧膝关节屈曲存在显著差异。23 例采用非手术治疗，9 例采用手术治疗。32 例髌骨骨折中，28 例确认愈合，末次随访 HSS 评分较术前显著提高。治疗后唯一的并发症是 3 例骨不连。根据治疗方法和骨折类型，我们未发现治疗结果有显著差异。
保留髌骨的全膝关节置换术后髌骨骨折并不常见，与文献报道的髌骨表面置换术后髌骨骨折相比，临床影像学结果有所改善。治疗效果不因治疗方法和骨折类型而异。
