Uimonen Mikko, Ponkilainen Ville, Mattila Ville M, Nurmi Heikki, Paloneva Juha, Repo Jussi P
Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyvaskyla, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Knee Surg Relat Res. 2023 Apr 13;35(1):10. doi: 10.1186/s43019-023-00186-2.
We characterized the relation of primary treatment approaches to the need of later surgical interventions and the outcomes of patellar dislocation in patients with patellofemoral osteochondral fracture (OCF).
Overall, 134 patients with OCF were categorized in two groups according to treatment approach: primary surgery (operation within 90 days from injury) and conservative treatment. Data on surgical procedures, OCF characteristics, and patellofemoral anatomy were retrospectively collected. To measure subjective outcomes, 54 patients completed the knee-specific patient-reported outcome measures (PROMs) Kujala score, Tegner activity scale, the knee injury and osteoarthritis outcome score (KOOS) quality of life (QoL) subscale, and visual analog scale pain items.
The mean follow-up time was 4.9 years [standard deviation (SD) 2.7 years]. The primary treatment approach was surgery in 73 patients (54%) and conservative in 61 patients (46%) of whim 18 (30%) needed late surgery. Of primary surgery patients, the OCF was reimplanted in 45 patients (62%) and removed in the rest. Of all patients, 31 needed surgery in the later phase after the primary treatment approach (either reoperation or surgery after insufficient outcome of conservative treatment). In conservatively treated patients, OCF was smaller and patellofemoral joint malformation was more severe than in surgery group. Among patients who completed the PROMs, the outcomes appeared generally acceptable in both groups.
Although a majority of the primary treatment approaches for OCF after patellar dislocation were definitive, one-fourth of patients required surgery in the later phase. PROMs did not indicate major differences between the study groups.
我们描述了初次治疗方法与髌股关节骨软骨骨折（OCF）患者后期手术干预需求及髌骨脱位结局之间的关系。
总体而言，134例OCF患者根据治疗方法分为两组：初次手术（受伤后90天内手术）和保守治疗。回顾性收集手术程序、OCF特征和髌股关节解剖学数据。为了测量主观结局，54例患者完成了膝关节特异性患者报告结局测量（PROMs）、库贾拉评分、特格纳活动量表、膝关节损伤和骨关节炎结局评分（KOOS）生活质量（QoL）子量表以及视觉模拟量表疼痛项目。
平均随访时间为4.9年[标准差（SD）2.7年]。初次治疗方法为手术的患者有73例（54%），保守治疗的患者有61例（46%），其中18例（30%）需要后期手术。在初次手术的患者中，45例（62%）的OCF被重新植入，其余患者的OCF被取出。在所有患者中，31例在初次治疗方法后的后期需要手术（再次手术或保守治疗效果不佳后手术）。在保守治疗的患者中，OCF较小，髌股关节畸形比手术组更严重。在完成PROMs的患者中，两组的结局总体上均可接受。
虽然髌骨脱位后OCF的大多数初次治疗方法是决定性的，但四分之一的患者在后期需要手术。PROMs未显示研究组之间的主要差异。
