改良垂直钢丝联合钢丝环扎内固定治疗髌骨下极骨折的效果及对骨代谢、疼痛因子的影响

Modified Vertical Wiring Combined with Wire Cerclage Internal Fixation in the Treatment of Inferior Patella Fracture and Its Effect on Bone Metabolism and Pain Factors

目的:对比改良垂直钢丝联合钢丝环扎内固定与钢丝张力带联合微型钢板固定对髌骨下极骨折患者术后膝关节功能及生活质量的影响,以及两者对骨代谢、疼痛介质的影响。方法:回顾性选取鹰潭一八四医院2021年6月—2022年12月诊治的99例髌骨下极骨折患者临床资料,根据手术方法不同,将改良垂直钢丝联合钢丝环扎内固定的髌骨下极骨折的患者作为观察组(50例),将钢丝张力带联合微型钢板固定的患者作为对照组(49例)。随访12个月,观察两组手术时间、切口长度、术中出血量、术后骨折愈合及功能恢复情况(Böstman评分、膝关节活动度)、术前术后疼痛视觉模拟评分(VAS)、术后3个月日常生活能力(Barthel指数)、骨代谢指标[血清骨钙素(BGP)、骨碱性磷酸酶(BALP)、骨膜蛋白(POSTN)]及疼痛介质水平[血清神经肽Y(NPY)、前列腺素E_(2)(PGE_(2))、P物质(SP)、多巴胺(DA)]。结果:两组手术时间、切口长度、术中出血量差异均无统计学意义(P>0.05);骨折愈合情况及功能恢复:两组术后骨折愈合时间差异无统计学意义(P>0.05),术后12个月观察组Böstman评分[(28.04±1.93)分]高于对照组[(25.53±2.45)分](P<0.05),两组术后膝关节活动度随着时间逐渐增高(P<0.05),且观察组术后1、3、6个月膝关节活动度均高于对照组(P<0.05)。观察组膝关节功能优率高于对照组(P<0.05);疼痛评分:两组术前、术后3 d、术后7 d的VAS评分差异均无统计学意义(P>0.05),术后30 d,观察组VAS评分低于对照组(P<0.05)。观察组Barthel指数为(82.53±10.29)分,高于对照组的(70.16±8.45)分(P<0.001)。术后30 d,观察组BGP、BALP、POSTN水平均高于对照组,NPY、PGE_(2)、SP、DA均低于对照组,差异均有统计学意义(P<0.05)。两组均无术后并发症。结论:改良垂直钢丝联合钢丝环扎内固定与钢丝张力带联合微型钢板固定治疗髌骨下极骨折均安全有效,调节骨代谢,抑制疼痛介质,改善患者膝关节功能,提高生活质量,但改良垂直钢丝联合钢丝环扎内固定在改善髌骨下极骨折患者膝关节功能方面更为优秀。

Objective:To compare the effects of modified vertical wiring combined with wire cerclage internal fixation and wire tension band combined with mini-plate fixation on postoperative knee joint function and quality of life in patients with inferior patella fracture,and their influence in bone metabolism and pain mediators.Method:The clinical data of 99 patients with inferior patella fracture in Yingtan No.184 Hospital from June 2021 to December 2022 were retrospectively selected.According to different surgical methods,patients with inferior patella fracture who were internally fixed with modified vertical wires combined with wire cerclage internal fixation were selected as the observation group(50 cases),patients fixed with steel wire tension bands combined with mini-plates fixation were selected as the control group(49 cases).The two groups were followed up for 12 months,and the operation time,incision length,intraoperative blood loss,postoperative fracture healing and functional recovery(Böstman score,knee joint mobility),preoperative and postoperative VAS,and Barthel index,and bone metabolic markers[serum bone gla protein(BGP),bone alkaline phosphatase(BALP),periostin(POSTN)]and pain mediators levels[serum neuropeptide Y(NPY),prostaglandin E_(2)(PGE_(2)),substance P(SP),dopamine(DA)]at 3 months after operation in both groups were observed.There was no postoperative complication in both groups.Result:There were no statistically significant differences in the operation time,incision length,and intraoperative blood loss between the two groups(P>0.05);fracture healing and functional recovery:there was no statistical difference in postoperative fracture healing time between the two groups(P>0.05),the Böstman score of the observation group[(28.04±1.93)points]was higher than that of the control group[(25.53±2.45)points]12 months after operation(P<0.05),and the postoperative knee joint mobility gradually of the two groups were increased over time(P<0.05),and the knee joint mobility of the observation group were higher than those of the control group 1,3,6 months after surgery(P<0.05).The rate of knee joint function in the observation group being excellent was higher than that in the control group(P<0.05);pain score:there were no significant differences in VAS scores between the two groups before operation,3 days and 7 days after operation(P>0.05).On the 30th day after operation,VAS score in the observation group was lower than that in the control group(P<0.05).The Barthel index of the observation group was(82.53±10.29)points,which was higher than(70.16±8.45)points of the control group(P<0.001).30 days after surgery,the BGP,BALP,and POSTN levels of the observation group were higher than those of the control group,while NPY,PGE_(2),SP,and DA were lower than those of the control group,the differences were statistically significant(P<0.05).Conclusion:Modified vertical wiring combined with wire cerclage internal fixation and steel wire tension band combined with micro-plate fixation are safe and effective in treating inferior patella fracture,can regulate bone metabolism,inhibit pain mediators,improve the function of patients'knee joints and quality of life,but modified vertical wiring combined with wire cerclage internal fixation is better at improving knee joint function in patients with inferior patella fracture.