Duan Keyou, Wang Zhaodong, Liu Yajun, Xu Chen, Zhu Zhonglian, Guan Jianzhong
Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233000, P. R. China.
Key Laboratory of Anhui Province for Tissue Transplantation, Bengbu Anhui, 233000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jan 15;39(1):75-82. doi: 10.7507/1002-1892.202410025.
To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents.
Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate). There was no significant difference in the baseline data of age, gender, side, cause of injury, Ogden classification, and time from injury to operation among the three groups ( >0.05). The range of motion (ROM), weight-bearing time, normal activity time of knee joint, and the hospital for special surgery (HSS) score at last follow-up were recorded and compared among the three groups. Recorded whether the fracture was displaced, whether the fracture line was blurred at 1 month after operation, whether there was epiphyseal dysplasia, and whether there was incision infection and other complications.
There was no significant difference in hospital stay between the groups ( >0.05). All patients were followed up 10-24 months, with an average of 14.3 months; there was no significant difference between the groups ( >0.05). All the incisions healed well without soft tissue irritation or fracture nonunion, and no limb shortening deformity or epiphyseal dysplasia was found during follow-up. At 1 month after operation, the knee joint ROM and hospitalization expenses in group A were better than those in groups B and C, the fracture healing time, knee joint weight-bearing time, and normal activity time of knee joint were better than those in group C, and the hospitalization expenses in group C were better than those in group B, with significant differences ( <0.05); there was no significant difference in the other indicators between the groups ( >0.05). In group A, the fracture line was blurred 1 month postoperatively, the fracture ends were in close contact, and there was no fracture displacement; in groups B and C, the fracture line was clear in 2 cases, and 1 case in group C had slight fracture displacement; except for 1 case in group B, there was no fracture split in the other two groups. There was no significant difference in the incidences of blur of fracture line, fracture displacement, and intraoperative bone split between the groups at 1 month after operation ( >0.05). At last follow-up, the HSS scores of knee joints in the three groups were excellent and good, and there was no significant difference between the groups ( >0.05).
Hollow screw combined with Kirschner wire tension band technique is effective in treating adolescent AFTT, which has the advantages of stabilizing fracture, accelerating fracture healing and rehabilitation, early feasible knee joint functional exercise, and reducing hospitalization expenses.
分析空心螺钉联合克氏针张力带、空心螺钉联合锚钉、改良1/3管状钢板三种内固定方法治疗青少年胫骨结节撕脱骨折（AFTT）的有效性。
选取2018年1月至2023年9月符合入选标准的19例青少年AFTT患者。根据不同内固定方法，将患者分为A组（8例，空心螺钉联合克氏针张力带）、B组（6例，空心螺钉联合锚钉）和C组（5例，改良1/3管状钢板）。三组患者的年龄、性别、患侧、受伤原因、Ogden分型以及受伤至手术时间等基线资料比较，差异无统计学意义（>0.05）。记录并比较三组患者末次随访时膝关节活动度（ROM）、负重时间、膝关节正常活动时间及美国特种外科医院（HSS）评分。记录骨折是否移位、术后1个月骨折线是否模糊、有无骨骺发育异常以及有无切口感染等并发症。
三组患者住院时间比较，差异无统计学意义（>0.05）。所有患者均获随访，随访时间10 - 24个月，平均14.3个月；三组比较，差异无统计学意义（>0.05）。所有切口均愈合良好，无软组织刺激或骨折不愈合，随访期间未发现肢体短缩畸形或骨骺发育异常。术后1个月，A组膝关节ROM及住院费用优于B组和C组，骨折愈合时间、膝关节负重时间及膝关节正常活动时间优于C组，C组住院费用优于B组，差异均有统计学意义（<0.05）；其他指标三组间比较，差异无统计学意义（>0.05）。A组术后1个月骨折线模糊，骨折端紧密接触，无骨折移位；B组和C组各有2例骨折线清晰，C组1例有轻度骨折移位；除B组1例，其他两组均无骨折裂开。术后1个月，三组骨折线模糊、骨折移位及术中骨裂开发生率比较，差异无统计学意义（>0.05）。末次随访时，三组膝关节HSS评分均为优、良，组间比较，差异无统计学意义（>0.05）。
空心螺钉联合克氏针张力带技术治疗青少年AFTT疗效确切，具有稳定骨折、加速骨折愈合及康复、早期可行膝关节功能锻炼、降低住院费用等优点。
