Chang Chih-Hsun, Shih Chien-An, Kuan Fa-Chuan, Hong Chih-Kai, Su Wei-Ren, Hsu Kai-Lan
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C.
Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan.
J Exp Orthop. 2023 Jun 1;10(1):58. doi: 10.1186/s40634-023-00622-y.
This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques.
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications.
A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case-control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11-90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device.
Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.
本研究旨在全面回顾有关髌骨下极骨折手术治疗的现有证据，并报告不同固定技术的结果及并发症。
本系统评价按照系统评价与Meta分析的首选报告项目（PRISMA）指南进行。于2023年3月检索了PubMed、Scopus和Web of Science。根据预先确定的纳入和排除标准对研究进行筛选。提取的数据包括骨折特征、手术技术以及影像学和功能结果。使用非随机研究方法学指数（MINORS）质量评估工具对符合条件的文献进行评估。主要结局是不同手术方法的术后活动范围，次要结局是其他临床结果和并发症。
共有42项研究满足所有纳入标准，被认为适合进行综述。选择了14项病例对照研究和28项病例系列研究，共1382例患者，平均年龄51.0岁（范围为11 - 90岁）。随访期为6至300个月。手术技术根据所用器械分为以下几类：（1）刚性固定器械；（2）张力固定器械；（3）混合器械；（4）髌骨外器械。
关于髌骨下极骨折手术治疗后的结果，除使用髌胫钢丝的技术效果较差外，每种技术的术后活动范围（ROM）为120°至135°。使用髌胫钢丝的患者功能评分也最低。术后并发症很少见，但约一半的患者需要额外手术取出植入物，尤其是那些初次手术使用刚性固定器械的患者。值得注意的是，不再推荐切除骨碎片，现在多种手术器械联合使用更为常见。
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