带线锚钉联合髌骨纵向钻孔Nice结捆扎技术治疗髌骨下极骨折

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture

目的探讨带线锚钉联合髌骨纵向钻孔Nice结捆扎技术治疗髌骨下极骨折的疗效。方法回顾性分析2017年6月—2021年6月收治且符合选择标准的37例单侧髌骨下极骨折患者临床资料。其中17例采用带线锚钉联合髌骨纵向钻孔Nice结捆扎技术(A组),20例采用传统克氏针张力带技术(B组)。两组患者性别、年龄、身体质量指数、骨折侧别、合并内科疾病以及术前血红蛋白等基线资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量、术后并发症发生情况、骨折愈合时间,以及末次随访时膝关节活动度、膝关节功能Bostman评分(运动范围、疼痛、日常工作、肌肉萎缩、助行辅助物、关节积液、打软腿、爬楼梯)及疗效评价。结果两组手术时间、术中出血量比较,差异均无统计学意义(P>0.05)。术后切口均Ⅰ期愈合。患者均获随访,随访时间1~2年,平均1.7年。X线片复查示,A组骨折均愈合,B组2例骨折不愈合;两组骨折愈合时间比较,差异无统计学意义(P>0.05)。末次随访时,A组膝关节活动度以及Bostman评分中的运动范围评分、总分以及疗效评定均优于B组(P<0.05),两组Bostman评分中其他各项评分差异均无统计学意义(P>0.05)。随访期间B组发生2例内固定失效、1例内固定激惹,A组无内固定相关并发症发生;A组并发症发生率低于B组,差异有统计学意义(P<0.05)。结论与传统克氏针张力带技术相比,带线锚钉联合髌骨纵向钻孔Nice结捆扎技术治疗髌骨下极骨折操作简便、固定牢靠,术后患者能尽早开始康复锻炼,膝关节功能恢复较好。

Objective To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures.Methods A clinical data of 37patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed.Among them,17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling(group A),and 20 cases were treated with the traditional Kirschner wire tension band technique(group B).There was no significant difference in terms of gender,age,body mass index,fracture side,combined medical disease,and preoperative hemoglobin between the two groups(P>0.05).Operation time,intraoperative blood loss,postoperative complications,fracture healing time,knee range of motion,and knee function Bostman score(range of motion,pain,daily work,muscle atrophy,walking aids,knee effusion,soft leg,and stair climbing)and grading were recorded in both groups at last follow-up.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).All incisions healed by first intention.All patients were followed up 1-2 years,with an average of 1.7 years.X-ray films reexamination showed that all fractures in group A healed,while 2 cases in group B did not heal.There was no significant difference in bone healing time between the two groups(P>0.05).At last follow-up,the knee range of motion,the range of motion score of Bostman score,total score and effectiveness grading in group A were significantly better than those in group B(P<0.05).There was no significant difference in the other items of Bostman scores between the two groups(P>0.05).During follow-up,2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B,and no complication related to internal fixation occurred in group A.The occurrence of complications was significantly lower in group A than in group B(P<0.05).Conclusion Compared with the traditional Kirschner wire tension band technique,the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation,reliable fixation,early flexion and extension activity,and better functional recovery of knee joint.