手部钢板固定系统与锚钉缝线固定治疗髌骨下极骨折的疗效比较

Comparison of hand plating system versus suture anchor fixation in treatment of patellar inferior pole fractures

目的:比较手部钢板固定系统(HPS)与经典锚钉缝线固定治疗髌骨下极骨折的疗效。方法:回顾性分析北部战区总医院骨科2018年1月至2019年12月期间收治的56例髌骨下极骨折患者资料。根据内固定方式不同分为两组:A组30例,男18例,女12例;年龄为(61.7±11.3)岁;采用HPS固定治疗。B组26例,男16例,女10例;年龄为(60.0±10.5)岁;采用锚钉缝线固定治疗。比较两组患者的手术切口长度、手术时间、术中出血量、骨折愈合时间、术后1年疼痛视觉模拟评分(VAS)、膝关节功能及随访期间并发症发生情况等。结果:两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。A组患者的手术时间[(59.4±10.8)min]显著短于B组患者[(66.5±12.3)min],差异有统计学意义(P<0.05);而两组患者的手术切口长度、术中出血量比较差异均无统计学意义(P>0.05)。A组与B组患者的骨折愈合时间分别为(11.2±1.8)、(12.1±2.4)周,术后1年疼痛VAS评分分别为(0.85±0.12)、(0.91±0.14)分,差异均无统计学意义(P>0.05)。A组患者术后1年屈膝角度(124.5°±14.6°)及膝关节Bostman功能评分[(29.3±3.5)分]显著优于B组患者[(113.2°±11.1°)、(26.2±2.9)分],差异均有统计学意义(P<0.05)。随访期间A组无一例患者发生并发症,B组2例患者发生内固定失效。结论:与经典锚钉缝线固定比较,HPS固定治疗髌骨下极骨块的固定更牢固,手术时间更短,膝关节功能恢复更好。

Objective To compare the clinical efficacy between hand plating system(HPS)and classic suture anchor fixation in the treatment of patellar inferior pole fractures.Methods The clinical data were analyzed retrospectively of the 56 patients who had been treated for patellar inferior pole fractures at Department of Orthopaedics,General Hospital of Northern Theatre Command from January 2018 to December 2019.They were assigned into 2 groups according to their internal fixation methods.In group A of 30 cases subjected to HPS fixation,there were 18 males and 12 females with an age of(61.7±11.3)years;in group B of 26 cases subjected to suture anchor fixation,there were 16 males and 10 females with an age of(60.0±10.5)years.The incision length,operation time,intraoperative bleeding,fracture union time,pain visual analog scale(VAS)and knee function one year postoperation,and follow-up complications were compared between the 2 groups.Results There was no significant difference in the preoperative general data between the 2 groups,showing comparability(P>0.05).The operation time in group A[(59.4±10.8)min]was significantly shorter than that in group B[(66.5±12.3)min](P<0.05).There was no significant difference in the incision length or intraoperative bleeding between the 2 groups(P>0.05).The bone union time was respectively(11.2±1.8)weeks and(12.1±2.4)weeks and the postoperative VAS respectively 0.85±0.12 and 0.91±0.14 for groups A and B,showing no significant difference between the 2 groups(P>0.05).The knee flexion angle(124.5°±14.6°)and knee Bostman score(29.3±3.5)in group A were significantly better than those in group B(113.2°±11.1°and 26.2±2.9)one year postoperation(P<0.05).Follow-up revealed no complication in group A but 2 cases of implant failure in group B.Conclusion Compared with the classical anchor suture fixation,HPS may obtain stronger fixation,shorter operation time and better knee function.