Gao Yanchun, Zhao Shichang, Yu Xingang, Qian Yun, Fu Dehao
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China.
J Orthop Surg Res. 2025 May 22;20(1):497. doi: 10.1186/s13018-025-05899-6.
To compare the clinical efficacy of the separate vertical wiring (SVW) technique and conventional tension band fixation in managing AO/OTA type A1 inferior pole patellar fractures, focusing on postoperative patella baja incidence and functional recovery.
From January 2019 to January 2023, 242 patients with AO/OTA A1 inferior pole patellar fractures undergoing surgical treatment were assigned to the SVW group (n = 117) or tension band (TB) group (n = 125). The primary outcome was the incidence of patella baja (Insall-Salvati index < 0.8) at the 12-month follow-up. Secondary outcomes included knee range of motion (ROM), Böstman functional score, and complications.
The SVW group demonstrated a significantly lower incidence of patella baja compared to the TB group (25.6% vs. 52.1%, P < 0.001), with higher mean (Insall-Salvati index) ISI values (0.87 ± 0.16 vs. 0.76 ± 0.12, P < 0.01). Knee ROM was superior in the SVW group (124.0°±14.2° vs. 119.9°±12.4°, P = 0.017), though no significant difference was observed in Böstman scores (25.1 ± 3.5 vs. 24.6 ± 3.6, P = 0.33). The overall complication rate was 5.8% (14/242), primarily comprising surgical site infections (3.5%, 8/242: 1.2% superficial, 2.1% deep), fixation failure (1.2%, 3/242), and nonunion (0.8%, 2/242). Notably, soft tissue irritation occurred exclusively in the TB group (8.8%, 11/125 vs. 0% in SVW; P = 0.005).
The SVW technique significantly reduces the risk of patella baja and improves knee range of motion by optimizing vertical tension distribution, establishing it as a biomechanically superior fixation strategy for AO/OTA A1 inferior pole patellar fractures. These findings support SVW as a first-line treatment for such complex injuries.
比较单独垂直钢丝固定（SVW）技术与传统张力带固定治疗AO/OTA A1型髌骨下极骨折的临床疗效，重点关注术后髌骨低位发生率和功能恢复情况。
2019年1月至2023年1月，242例接受手术治疗的AO/OTA A1型髌骨下极骨折患者被分为SVW组（n = 117）或张力带（TB）组（n = 125）。主要结局是随访12个月时髌骨低位（Insall-Salvati指数<0.8）的发生率。次要结局包括膝关节活动范围（ROM）、Böstman功能评分和并发症。
与TB组相比，SVW组髌骨低位发生率显著更低（25.6%对52.1%，P < 0.001），平均（Insall-Salvati指数）ISI值更高（0.87±0.16对0.76±0.12，P < 0.01）。SVW组膝关节ROM更优（124.0°±14.2°对119.9°±12.4°，P = 0.017），不过Böstman评分无显著差异（25.1±3.5对24.6±3.6，P = 0.33）。总体并发症发生率为5.8%（14/242），主要包括手术部位感染（3.5%，8/242：浅表1.2%，深部2.1%）、固定失败（1.2%，3/242）和骨不连（0.8%，2/242）。值得注意的是，软组织刺激仅发生在TB组（8.8%，11/125对SVW组0%；P = 0.005）。
SVW技术通过优化垂直张力分布显著降低了髌骨低位风险并改善了膝关节活动范围，确立其为AO/OTA A1型髌骨下极骨折生物力学上更优的固定策略。这些发现支持将SVW作为此类复杂损伤的一线治疗方法。
