新型可吸收空心螺钉结合不可吸收缝线张力带固定治疗髌骨骨折:与传统改良张力带的对比
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摘要
背景:对于髌骨横行骨折的治疗,传统改良张力带有需要二次手术的风险,并且也需要较长的康复时间。同时还有报道克氏针或钢丝刺破皮肤、引起疼痛等缺点,因此对于治疗方案的改进空间较大。目的:比较可吸收空心螺钉拉力与不可吸收缝线结合张力带固定与传统改良张力带固定治疗髌骨骨折的方法与临床疗效。方法:回顾性分析髌骨横行骨折患者49例的临床资料,其中采用可吸收空心螺钉与不可吸收缝线结合张力带固定的患者16例(A组),采用传统改良张力带的患者33例(B组)。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。定量或定性比较:术后恢复正常活动时间、住院费用;术后第1天、3个月、6个月膝关节正侧位X射线片;受伤前、术后6,12个月的膝关节功能评分,包括Lysholm和国际膝关节文献委员会评分。结果与结论:①受伤前、术后6个月及术后12个月,A组、B组组内在Lysholm评分和国际膝关节文献委员会评分上差异均有显著性意义(P<0.001);术后6个月,A组评分显著高于B组(P<0.001);术后12个月2组之间差异无显著性意义(P>0.05);②B组患者恢复日常活动所需时间长于A组(P=0.03);③A组患者平均医疗费用为人民币7 833元(8 000-10 000元),B组2次手术费用总和平均为11 769元(10 000-20 000元),B组显著高于A组(P <0.05);④2组患者术后第1天复查X射线片示骨折端对位、对线良好无明显错位,髌骨关节面光滑平整;A组术后3个月X射线片示骨折线模糊,钉帽模糊可见;术后6个月X射线片示骨折线消失,钉帽不可见。B组术后3个月X射线片示有克氏针及钢丝脱离的发生;⑤提示相对于传统改良张力带,新型可吸收空心螺钉与不可吸收缝线张力带在固定治疗髌骨骨折上能取得更好的疗效,可作为未来一种替代的手术方式。
BACKGROUND: For transverse patella fractures, traditional advanced tension band possesses the risk for secondary surgery, which needs long-term rehabilitation. Kirschner wire or steel wire may pierce the skin and cause pain, so the treatment scheme needs to be improved.OBJECTIVE: To compare the clinical efficacy of absorbable cannulated screw combined with non-absorbable suture-tension band and traditional advanced tension band for treating patella fractures.METHODS: Clinical data of 49 patients with transverse patella fractures were analyzed retrospectively, including 16 cases of absorbable cannulated screw combined with non-absorbable suture-tension band(group A) and 33 cases of modified traditional tension band(group B).All patients signed the informed contents, and the study was approved by the ethics committee of the hospital. The time of returning normal activity and hospitalization cost were compared. The anteroposterior and lateral film of the knee joint at postoperative 1 day, 3 and 6 months,and the Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months were compared.RESULTS AND CONCLUSION:(1) Both groups showed improved Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months(P < 0.001). The scores at postoperative 6 months in the group A were significantly higher than those in the group B(P < 0.001). There was no significant difference in the scores at postoperative 12 months between two groups(P > 0.05).(2)The time of returning normal activity in the group B was significantly longer than that in the group A(P=0.03).(3) The average hospitalization cost in the group A was $7 833($8 000-10 000), and $11 769($10 000-20 000) in the group B(P < 0.05).(4) At postoperative 1 day, the X-ray films showed a good alignment and no obvious dislocation, and articular surface was smooth and flat in both groups. At postoperative 3 months, the group A showed obscure fracture line and the obscure nail cap on the X-rays. Fracture line disappeared and the nail cap was invisible in the group A at postoperative 6 months. In the group B, detachment of the wire and needle was observed at postoperative 3 months.(5) In summary, compared with the traditional advanced tension band, the novel absorbable cannulated screw combined with non-absorbable suture-tension band exerts better clinical outcomes in the treatment of transverse patellar fractures, which is considered as an alternative method.
BACKGROUND: For transverse patella fractures, traditional advanced tension band possesses the risk for secondary surgery, which needs long-term rehabilitation. Kirschner wire or steel wire may pierce the skin and cause pain, so the treatment scheme needs to be improved.OBJECTIVE: To compare the clinical efficacy of absorbable cannulated screw combined with non-absorbable suture-tension band and traditional advanced tension band for treating patella fractures.METHODS: Clinical data of 49 patients with transverse patella fractures were analyzed retrospectively, including 16 cases of absorbable cannulated screw combined with non-absorbable suture-tension band(group A) and 33 cases of modified traditional tension band(group B).All patients signed the informed contents, and the study was approved by the ethics committee of the hospital. The time of returning normal activity and hospitalization cost were compared. The anteroposterior and lateral film of the knee joint at postoperative 1 day, 3 and 6 months,and the Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months were compared.RESULTS AND CONCLUSION:(1) Both groups showed improved Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months(P < 0.001). The scores at postoperative 6 months in the group A were significantly higher than those in the group B(P < 0.001). There was no significant difference in the scores at postoperative 12 months between two groups(P > 0.05).(2)The time of returning normal activity in the group B was significantly longer than that in the group A(P=0.03).(3) The average hospitalization cost in the group A was $7 833($8 000-10 000), and $11 769($10 000-20 000) in the group B(P < 0.05).(4) At postoperative 1 day, the X-ray films showed a good alignment and no obvious dislocation, and articular surface was smooth and flat in both groups. At postoperative 3 months, the group A showed obscure fracture line and the obscure nail cap on the X-rays. Fracture line disappeared and the nail cap was invisible in the group A at postoperative 6 months. In the group B, detachment of the wire and needle was observed at postoperative 3 months.(5) In summary, compared with the traditional advanced tension band, the novel absorbable cannulated screw combined with non-absorbable suture-tension band exerts better clinical outcomes in the treatment of transverse patellar fractures, which is considered as an alternative method.
引文
[1]Larsen P,Court-Brown CM,Vedel JO,et al.Incidence and epidemiology of patellar fractures.Orthopedics.2016;39:e1154-e1158.
[2]Cerciello S,Cote M,Lustig S,et al.Arthroscopically assisted fixation is a reliable option for patellar fractures:A literature review.Orthop Traumatol Surg Res.2017;103:1087-1091.
[3]Gwinner C,M?rdian S,Schwabe P,et al.Current concepts review:Fractures of the patella.GMS Interdiscip Plast Reconstr Surg DGPW.2016;5:Doc01.
[4]Kakazu R,Archdeacon MT.Surgical management of patellar fractures.Orthop Clin North Am.2016;47:77-83.
[5]George DA,Dosani A,Morgan-Jones R.Patellar reconstruction following previous patellectomy:a review of the literature and a case series using distal femoral autograft during total knee arthroplasty.Ann R Coll Surg Engl.2017;99:e97-e101.
[6]Zderic I,Stoffel K,Sommer C,et al.Biomechanical evaluation of the tension band wiring principle.A comparison between two different techniques for transverse patella fracture fixation.Injury.2017;48:1749-1757.
[7]Tian QX,Hai Y,Du XR,et al.Comparison of Tension-Band Wiring With the Cable Pin System in Patella Fractures:A Randomized Prospective Study.J Orthop Trauma.2015;29:e459-463.
[8]Melvin JS,Mehta S.Patellar fractures in adults.J Am Acad Orthop Surg.2011;19:198-207.
[9]Baruah RK.Modified Ilizarov in difficult Fracture of the Patella.Acase report.J Orthop Case Rep.2106;6:26-28.
[10]Miles DT,Graves ML,Spitler CA,et al.Failure of Patellar Plating with Mini-Fragment Implants:A Case Report.JBJS Case Connect.2017;7:e13.
[11]Carpenter JE,Kasman R,Matthews LS.Fractures of the patella.Instr Course Lect.1994;43:97-108.
[12]Berg EE.Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws.J Orthop Trauma.1997;11:573-576.
[13]Qi L,Chang C,Xin T,et al.Double fixation of displaced patella fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands.Injury.2011;42:1116-1120.
[14]Hsu KL,Chang WL,Yang CY,et al.Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures.Injury.2017;48:2800-2806.
[15]Hoshino CM,Tran W,Tiberi JV,et al.Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires.J Bone Joint Surg Am.2013;95:653-659.
[16]Huang SL,Xue JL,Gao ZQ,et al.Management of patellar fracture with titanium cable cerclage.Medicine(Baltimore).2017;96:e8525.
[17]B?stman O,Kiviluoto O,Santavirta S,et al.Fractures of the patella treated by operation.Arch Orthop Trauma Surg.1983;102:78-81.
[18]Smith ST,Cramer KE,Karges DE,et al.Early complications in the operative treatment of patella fractures.J Orthop Trauma.1997;11:183-187.
[19]Wang CX,Tan L,Qi BC,et al.A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture.Chin J Traumatol.2014;17:208-213.
[20]Tian Y,Zhou F,Ji H,et al.Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures.Clin Orthop Relat Res.2011;469:3429-3435.
[21]Dargel J,Gick S,Mader K,et al.Biomechanical comparison of tension band-and interfragmentary screw fixation with a new implant in transverse patella fractures.Injury.2010;41:156-160.
[22]Sayum Filho J,Lenza M,Teixeira de Carvalho R,et al.Interventions for treating fractures of the patella in adults.Cochrane Database Syst Rev.2015;69:CD009651.
[23]Wild M,Eichler C,Thelen S,et al.Fixed-angle plate osteosynthesis of the patella-an alternative to tension wiring?Clin Biomech(Bristol,Avon).2010;25:341-347.
[24]Yang X,Wu Q,Lai CH,et al.Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System.Injury.2017;48:2348-2353.
[25]Kyung MG,Lee SH,Kim MB.Complications Related to Implant Fixation of Patellar Fractures:Comparison of Ring Pins versus Bent K-Wires.J Knee Surg.2017;30:560-564.
[26]Camarda L,La Gattuta A,Butera M,et al.FiberWire tension band for patellar fractures.J Orthop Traumatol.2016;17:75-80.
[27]Petrie J,Sassoon A,Langford J.Complications of patellar fracture repair:treatment and results.J Knee Surg.2013;26:309-312.
[28]Lin T,Liu J,Xiao B,et al.Comparison of the outcomes of cannulated screws vs.modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures.BMC Musculoskelet Disord.2015;16:282.
[29]Malik M,Halwai MA.Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.JKnee Surg.2014;27:377-382.
[30]Tandogan RN,Demirors H,Tuncay CI,et al.Arthroscopic-assisted percutaneous screw fixation of select patellar fractures.Arthroscopy.2002;18:156-162.
[2]Cerciello S,Cote M,Lustig S,et al.Arthroscopically assisted fixation is a reliable option for patellar fractures:A literature review.Orthop Traumatol Surg Res.2017;103:1087-1091.
[3]Gwinner C,M?rdian S,Schwabe P,et al.Current concepts review:Fractures of the patella.GMS Interdiscip Plast Reconstr Surg DGPW.2016;5:Doc01.
[4]Kakazu R,Archdeacon MT.Surgical management of patellar fractures.Orthop Clin North Am.2016;47:77-83.
[5]George DA,Dosani A,Morgan-Jones R.Patellar reconstruction following previous patellectomy:a review of the literature and a case series using distal femoral autograft during total knee arthroplasty.Ann R Coll Surg Engl.2017;99:e97-e101.
[6]Zderic I,Stoffel K,Sommer C,et al.Biomechanical evaluation of the tension band wiring principle.A comparison between two different techniques for transverse patella fracture fixation.Injury.2017;48:1749-1757.
[7]Tian QX,Hai Y,Du XR,et al.Comparison of Tension-Band Wiring With the Cable Pin System in Patella Fractures:A Randomized Prospective Study.J Orthop Trauma.2015;29:e459-463.
[8]Melvin JS,Mehta S.Patellar fractures in adults.J Am Acad Orthop Surg.2011;19:198-207.
[9]Baruah RK.Modified Ilizarov in difficult Fracture of the Patella.Acase report.J Orthop Case Rep.2106;6:26-28.
[10]Miles DT,Graves ML,Spitler CA,et al.Failure of Patellar Plating with Mini-Fragment Implants:A Case Report.JBJS Case Connect.2017;7:e13.
[11]Carpenter JE,Kasman R,Matthews LS.Fractures of the patella.Instr Course Lect.1994;43:97-108.
[12]Berg EE.Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws.J Orthop Trauma.1997;11:573-576.
[13]Qi L,Chang C,Xin T,et al.Double fixation of displaced patella fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands.Injury.2011;42:1116-1120.
[14]Hsu KL,Chang WL,Yang CY,et al.Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures.Injury.2017;48:2800-2806.
[15]Hoshino CM,Tran W,Tiberi JV,et al.Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires.J Bone Joint Surg Am.2013;95:653-659.
[16]Huang SL,Xue JL,Gao ZQ,et al.Management of patellar fracture with titanium cable cerclage.Medicine(Baltimore).2017;96:e8525.
[17]B?stman O,Kiviluoto O,Santavirta S,et al.Fractures of the patella treated by operation.Arch Orthop Trauma Surg.1983;102:78-81.
[18]Smith ST,Cramer KE,Karges DE,et al.Early complications in the operative treatment of patella fractures.J Orthop Trauma.1997;11:183-187.
[19]Wang CX,Tan L,Qi BC,et al.A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture.Chin J Traumatol.2014;17:208-213.
[20]Tian Y,Zhou F,Ji H,et al.Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures.Clin Orthop Relat Res.2011;469:3429-3435.
[21]Dargel J,Gick S,Mader K,et al.Biomechanical comparison of tension band-and interfragmentary screw fixation with a new implant in transverse patella fractures.Injury.2010;41:156-160.
[22]Sayum Filho J,Lenza M,Teixeira de Carvalho R,et al.Interventions for treating fractures of the patella in adults.Cochrane Database Syst Rev.2015;69:CD009651.
[23]Wild M,Eichler C,Thelen S,et al.Fixed-angle plate osteosynthesis of the patella-an alternative to tension wiring?Clin Biomech(Bristol,Avon).2010;25:341-347.
[24]Yang X,Wu Q,Lai CH,et al.Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System.Injury.2017;48:2348-2353.
[25]Kyung MG,Lee SH,Kim MB.Complications Related to Implant Fixation of Patellar Fractures:Comparison of Ring Pins versus Bent K-Wires.J Knee Surg.2017;30:560-564.
[26]Camarda L,La Gattuta A,Butera M,et al.FiberWire tension band for patellar fractures.J Orthop Traumatol.2016;17:75-80.
[27]Petrie J,Sassoon A,Langford J.Complications of patellar fracture repair:treatment and results.J Knee Surg.2013;26:309-312.
[28]Lin T,Liu J,Xiao B,et al.Comparison of the outcomes of cannulated screws vs.modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures.BMC Musculoskelet Disord.2015;16:282.
[29]Malik M,Halwai MA.Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.JKnee Surg.2014;27:377-382.
[30]Tandogan RN,Demirors H,Tuncay CI,et al.Arthroscopic-assisted percutaneous screw fixation of select patellar fractures.Arthroscopy.2002;18:156-162.