Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
Trauma Center, West China Hospital of Sichuan University, Chengdu, 610041, China.
BMC Surg. 2023 Aug 23;23(1):251. doi: 10.1186/s12893-023-02153-w.
Surgical management of comminuted patella fractures remains a major challenge for the surgeon. We developed a suture reduction (SR) technique to better preserve the comminuted patella. The study aimed to compare the suture reduction technique with conventional reduction (CR) technique in the management of comminuted patellar fractures using the modified Kirschner-wire (K-wire) tension band.
From May 2016 to September 2020, a total of 75 patients with comminuted patellar fracture were reviewed retrospectively. Among these cases, 35 patients were in the suture reduction group with a mean age of 52 years, while 40 patients were in the conventional reduction group with a mean age of 53 years. All cases were closed fractures. Comminuted patellar fractures were classified as type 34-C3 according to the AO/OTA classification. Radiographs of the knee were obtained at routine follow-up to evaluate the reduction quality and fracture union. Clinical outcomes including range of motion (ROM), visual analog scale (VAS), Lysholm, and Böstman grading scales were measured at the last follow-up. Postoperative complications were also recorded.
The average time from injury to surgery was 5.4 days in suture reduction group and 3.7 days in conventional reduction group (p < 0.05). The surgical time of suture reduction group was less than that of conventional reduction group, but there was no significant difference (p = 0.110) regarding surgical time between the two groups. The average blood loss in suture reduction group was 42.9 ml, while the average blood loss in conventional reduction group was 69.3 ml (p < 0.001). There was no difference regarding fracture union, ROM and knee function score (Lysholm score and Böstman scale) between the two groups. The complication rates were 17.1% in suture reduction group and 12.5% in conventional reduction group respectively (p > 0.05).
In the treatment of comminuted patellar fractures with modified K-wire tension band, the use of suture reduction technique can shorten the surgical time, reduce the surgical trauma, and obtain satisfactory results. This new surgical technique may be particularly effective in management of comminuted patellar fractures when patellectomy would otherwise be considered.
粉碎性髌骨骨折的手术治疗仍然是外科医生面临的主要挑战。我们开发了一种缝线复位（SR）技术，以更好地保留粉碎性髌骨。本研究旨在比较缝线复位技术与传统复位（CR）技术在使用改良克氏针张力带治疗粉碎性髌骨骨折中的应用。
回顾性分析 2016 年 5 月至 2020 年 9 月收治的 75 例粉碎性髌骨骨折患者。其中，35 例患者采用缝线复位组，平均年龄 52 岁，40 例患者采用传统复位组，平均年龄 53 岁。所有患者均为闭合性骨折。根据 AO/OTA 分类，粉碎性髌骨骨折分为 34-C3 型。膝关节常规随访时拍摄 X 线片，评估复位质量和骨折愈合情况。末次随访时测量膝关节活动度（ROM）、视觉模拟评分（VAS）、Lysholm 评分和 Böstman 评分等临床疗效。记录术后并发症。
缝线复位组从受伤到手术的平均时间为 5.4 天，传统复位组为 3.7 天（p<0.05）。缝线复位组的手术时间短于传统复位组，但差异无统计学意义（p=0.110）。缝线复位组平均出血量为 42.9ml，传统复位组平均出血量为 69.3ml（p<0.001）。两组骨折愈合、ROM 和膝关节功能评分（Lysholm 评分和 Böstman 评分）无差异。缝线复位组并发症发生率为 17.1%，传统复位组为 12.5%（p>0.05）。
改良克氏针张力带治疗粉碎性髌骨骨折时，采用缝线复位技术可缩短手术时间，减少手术创伤，获得满意效果。当需要行髌骨切除术时，这种新的手术技术可能对粉碎性髌骨骨折的治疗特别有效。
