Noothan P T, Somashekara S A, Sunkappa S R, Karthik B, Rameshkrishnan K
Fort, Krishna Rajendra Road, Bangalore, 560002 India Department of Orthopaedics, Bangalore Medical College and Research Institute.
Indian J Orthop. 2023 Mar 24;57(6):876-883. doi: 10.1007/s43465-022-00778-2. eCollection 2023 Jun.
Patellar fractures account for 1% of all skeletal injuries. Tension band wiring using SS wire has been the most commonly practiced procedure. Although this has shown good results, many patients experience hardware related problems like pain, irritation and prominence which necessitate it's removal. Recent studies have highlighted braided sutures as a possible alternative to SS wire. The purpose of this study is to evaluate the functional and radiological outcomes and complications of TBW using SS wire versus FiberWire (a reinforced braided polyblend suture) for the treatment of displaced transverse patellar fractures.
A randomized comparative study was carried out at a tertiary care center from November 2019 to May 2021. 32 patients were randomized into two equal groups, one treated with TBW using FiberWire and the other with SS wire. Patients were followed up for a period of 20 weeks and evaluated for functional outcome using the Bostman scoring scale, radiological union, complications and hardware removal rates.
The mean duration for radiological union was 12.85 weeks using FiberWire and 12.75 weeks using SS wire. The mean knee range of motion was 118.57° in the FiberWire group and 117.18° in the SS wire group. Functional scores in the FiberWire and SS wire groups were 24 (good) and 26 (good) respectively measured using the Bostman scoring scale at end of 20 weeks. Complications like hardware prominence, soft tissue irritation and hardware removal rates were significantly higher in the SS wire group with a value of 0.023.
SS wire is biomechanically stronger than FiberWire when used for TBW. Both implants produce comparable results with respect to union rate, ROM and functional outcome, however, FiberWire causes fewer hardware complications like prominence and pain and hence alleviates the need for a second surgical procedure for implant removal. Thus, surgical treatment of transverse and inferior pole of patella fractures with TBW using FiberWire is a better alternative to SS wire considering early rehabilitation and lesser complication rates.
髌骨骨折占所有骨骼损伤的1%。使用不锈钢丝的张力带钢丝固定术是最常用的手术方法。尽管这已显示出良好的效果，但许多患者会出现与内固定相关的问题，如疼痛、刺激和突出，这就需要取出内固定。最近的研究强调编织缝线可能是不锈钢丝的一种替代方法。本研究的目的是评估使用不锈钢丝与纤维线（一种增强编织聚混纺缝线）进行张力带钢丝固定术治疗移位的横行髌骨骨折的功能和影像学结果及并发症。
2019年11月至2021年5月在一家三级医疗中心进行了一项随机对照研究。32例患者被随机分为两组，每组人数相等，一组采用纤维线进行张力带钢丝固定术治疗，另一组采用不锈钢丝治疗。对患者进行了为期20周的随访，并使用博斯特曼评分量表评估功能结果、影像学骨愈合情况、并发症及内固定取出率。
使用纤维线时影像学骨愈合的平均时间为12.85周，使用不锈钢丝时为12.75周。纤维线组的平均膝关节活动范围为118.57°，不锈钢丝组为117.18°。在20周结束时，使用博斯特曼评分量表测得，纤维线组和不锈钢丝组的功能评分分别为24分（良好）和26分（良好）。不锈钢丝组的内固定突出、软组织刺激等并发症及内固定取出率显著更高，P值为0.023。
在用于张力带钢丝固定术时，不锈钢丝在生物力学上比纤维线更强。两种植入物在骨愈合率、关节活动度和功能结果方面产生的结果相当，然而，纤维线引起的内固定相关并发症如突出和疼痛更少，因此减少了进行第二次取出植入物手术的必要性。因此，考虑到早期康复和较低的并发症发生率，使用纤维线进行张力带钢丝固定术治疗横行和髌骨下极骨折是比不锈钢丝更好的选择。
