克氏针张力带与髌骨爪内固定治疗髌骨下极骨折的疗效比较

Effect of Kirschner tension-band wire and memory alloy patellar holder in treating inferior polar fracture of patella

目的比较克氏针张力带与髌骨爪2种内固定术治疗髌骨下极骨折的疗效，为临床选择术式提供参考依据。方法选择2003年1月至2010年1月在我院分别采用克氏针张力带、髌骨爪内同定手术治疗髌骨下极骨折病例92例。采用张力带内固定术治疗患者53例（张力带组），其中粉碎性骨折患者45例，非粉碎性骨折8例；采用髌骨爪内同定术治疗患者39例（髌骨爪组），其中粉碎性骨折患者35例，非粉碎性骨折4例。观察并比较手术时长、手术后骨折愈合时间、术后疗效、并发症发生率、住院费用等。结果术后随访6～18个月，平均（11．5±1．0）个月。①非粉碎骨折性患者中，张力带组、髌骨爪组患者在手术时长、骨折愈合时间、平均住院费用（不含手术材料费）、术后疗效、术后并发症发生率方面差异均无统计学意义（P〉0．05），但髌骨爪组总住院费用明显高于张力带组[（7148±155）元比（5490±129）元，P〈0．01]。②在粉碎性骨折患者中，张力带组手术时长、术后并发症发生率明显高于髌骨爪组[（63．6±2．5）rain比（48．3±2．2）min，8．9％（4／45）比0．0％，P〈0．05或P〈0．01]；张力带组、髌骨爪组骨折愈合时间、平均住院费用（不含手术材料费）差异无统计学意义（P〉0．05）；髌骨爪组总住院费用明显高于张力带组[（7337±185）元比（5623±134）元，P〈0．01]，髌骨爪组有效率高于张力带组[100．0％（35／35）比91．1％（41／45），P〈0．05]。结论在非粉碎性骨折治疗中，髌骨爪内同定住院费用明显高于克氏针张力带术，疗效无明显差别，克氏针张力带更适用于基层医疗机构，推荐为首选治疗方法；在粉碎性骨折治疗中，髌骨爪内同定相对克氏针张力带更牢靠，并发症少，可降低手术难度、时间、风险，推荐为粉碎性骨折治疗首选。

Objective To compare the therapeutic effects of Kirschner tension-band wire and memory alloy patellar holder in the treatment of inferior polar fracture of patella. Methods All 92 patients with inferior polar fracture of patella treated with Kirschner tension-band wire or memory alloy patellar holder were selected. Of 92 patients, 53 cases suffered Kirschner tension-band wire including 45 cases with comminuted fractures, 39 cases underwent memory alloy patellar holder including 35 cases with comminuted fractures. All cases were performed surgical reduction and internal fixation under spinal anesthesia. The results were analyzed based on their surgical duration, fracture healing time, postoperative effects, complication rate and cost of hospitalization. Results Patients were followed up for 6 to 18 months, with an average of （ 11.5 ± 1.0） months. ① For patients with non-comminuted fracture, there was no significant difference between two groups in terms of surgical duration, fracture healing time, the hospital costs （excluding cost for surgical materials）, the incidence rate of complication and postoperative effects （ P 〉 0. 05 ）. Patients with patellar holder had a lower rate of complication （ P 〈 0. 05 ）. There was significant differ- ence in average total hospital costs between patients with patellar holder and patients with Kirschner tension-band wire [ （7148 ± 155）yuan vs（5490 ± 129）yuan, P 〈0.01 ]. ② For patients with comminuted fracture, there was no significant difference in fracture healing time between two groups （ P 〉 0.05 ）, but there was significant difference in terms of the curative effect[ 100.0% （35/35） vs 91.1% （41/45）, P 〈0.05]. For patients with Kirschner tension- band wire, the surgical duration and rate of complications were significantly higher than those in the other group [ （63.6 ±2.5）min vs（48.3 _±2.2）rain, 8.9% （4/45） vs 0.0%, P 〈0.05 or P〈0.01]. There was a significant difference in average total hospital costs between patients with patel]ar holder and patients with Kirsehner tensionband wire [ （7337 ± 185 ）yuan vs （5623 ± 134 ） yuan, P 〈 0.01 ]. Conclusions In the treatment of non-comminuted fracture of the patella, Kirschner tension-band wire is recommended as the preferred treatment method as it is more applicable to primary health care sectors. For comminuted fracture of patella, it is more reliable with fewer complications if patellar holder is used. As it could reduce difficulty of operation, surgical duration and risk, it is highly recommended for the treatment of comminuted fracture.