Yang Huan, Yuan Yusong, Shi Lei, Si Fangda, Liu Jiaqi, Chen Ying, Xu Xiaodong
Orthopedic Trauma, China-Japan Friendship Hospital, Beijing, China.
Front Surg. 2025 Sep 1;12:1594907. doi: 10.3389/fsurg.2025.1594907. eCollection 2025.
To compare the clinical efficacy and safety of the dual cannulated screw-cable (DCSC) system with those of conventional Kirschner wire-cable (KWC) fixation in the management of patellar fractures. Traditional KWC fixation, while widely used since the 1970s, is associated with high complication rates, including symptomatic hardware irritation (up to 42%) and loss of reduction (12%-15% in transverse fractures), due to its biomechanical limitations such as lack of interfragmentary compression and prominent hardware causing soft tissue irritation. The DCSC system, introduced as a promising alternative, offers active interfragmentary compression and reduced soft tissue irritation, potentially addressing these limitations. However, few clinical studies have directly compared the outcomes of DCSC and KWC fixation in patellar fractures. This study aims to fill this gap by evaluating functional recovery, radiographic union, and complication rates between the two fixation methods.
This retrospective cohort study included 127 patients with patellar fractures (AO/OTA 34-C) treated between January 2020 and December 2023. The patients were stratified into DCSC ( = 26) and KWC ( = 101) groups. The primary outcomes included functional recovery (Lysholm and Böstman scores) at 3 and 12 months postoperatively. The secondary outcomes included radiographic union time, complication rates, and reoperation rates. Between-group comparisons were performed using t tests and chi-square tests ( < 0.05).
The DCSC group demonstrated superior short-term functional outcomes, with significantly higher Lysholm scores at 3 months (76.0 ± 6.1 vs. 70.4 ± 2.9, < 0.001) and significantly higher Böstman scores across all fracture classifications (C1: 21.5 vs. 17.5; C2: 21.6 vs. 17.2; C3: 21.3 vs. 17.6; all < 0.001). Notably, C2 fractures treated with DCSC exhibited the greatest improvement in Lysholm scores (at 3 months, < 0.001). DCSC also resulted in shorter operative times (62.9 ± 1.8 vs. 76.0 ± 1.4 min, < 0.001) and reduced symptomatic hardware irritation (3.8% vs. 21.8%, = 0.03). Radiographic union was faster in the DCSC group (3.04 vs. 3.50 months, < 0.001). However, the Lysholm and Böstman scores at 12 months were similar between the groups ( > 0.05), and the reoperation rates at 12 months were comparable (3.8% vs. 2.0%, = 0.82).
Compared with KWC fixation, the DCSC system provides superior early functional recovery, fewer complications, and faster fracture healing, particularly in complex intra-articular fractures (OTA 34-C2). However, the benefits of the DCSC system in simpler or more comminuted fracture (C1/C3) diminish over time, and caution is warranted when using this system in comminuted or distal coronal plane fractures owing to potential compression limitations. These findings support the use of DCSC as a first-line option for C2 fractures, although long-term studies are needed to assess implant durability.
比较双空心钉-缆线（DCSC）系统与传统克氏针-缆线（KWC）固定方法治疗髌骨骨折的临床疗效和安全性。传统的KWC固定方法自20世纪70年代以来广泛应用，但由于其生物力学局限性，如缺乏骨折块间加压以及突出的内固定物导致软组织刺激，并发症发生率较高，包括有症状的内固定物刺激（高达42%）和复位丢失（横行骨折中为12%-15%）。作为一种有前景的替代方法引入的DCSC系统，提供了主动的骨折块间加压并减少了软组织刺激，可能解决了这些局限性。然而，很少有临床研究直接比较DCSC和KWC固定治疗髌骨骨折的结果。本研究旨在通过评估两种固定方法之间的功能恢复、影像学愈合及并发症发生率来填补这一空白。
这项回顾性队列研究纳入了2020年1月至2023年12月期间治疗的127例髌骨骨折（AO/OTA 34-C）患者。患者被分为DCSC组（n = 26）和KWC组（n = 101）。主要结局包括术后3个月和12个月时的功能恢复情况（Lysholm和Böstman评分）。次要结局包括影像学愈合时间、并发症发生率和再次手术率。组间比较采用t检验和卡方检验（P < 0.05）。
DCSC组显示出更好的短期功能结局，在3个月时Lysholm评分显著更高（76.0 ± 6.1 vs. 70.4 ± 2.9，P < 0.001），并且在所有骨折分类中Böstman评分均显著更高（C1：21.5 vs. 17.5；C2：21.6 vs. 17.2；C3：21.3 vs. 17.6；均P < 0.001）。值得注意的是，采用DCSC治疗的C2骨折在Lysholm评分上改善最大（3个月时，P < 0.001）。DCSC还导致手术时间更短（62.9 ± 1.8 vs. 76.0 ± 1.4分钟，P < 0.001）以及有症状的内固定物刺激减少（3.8% vs. 21.8%，P = 0.03）。DCSC组的影像学愈合更快（3.
