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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 732 -735. doi: 10.3877/cma.j.issn.1674-134X.2023.05.021

临床经验

带线锚钉结合缝线捆扎固定髌骨下极粉碎性骨折
陈志超†(), 张志伟, 蒋勰, 顾祖超, 蒋菁芸, 许婷婷   
  1. 610041　成都市第一人民医院骨科
  • 收稿日期:2023-04-04 出版日期:2023-10-01
  • 通信作者: 陈志超

Treatment of comminuted fracture of inferior pole of patella with suture anchor combined suture binding

Zhichao Chen†(), Zhiwei Zhang, Xie Jiang, Zuchao Gu, Jingyun Jiang, Tingting Xu   

  1. Department of Orthopedics, Chengdu First People's Hospital, Chengdu 610041, China
  • Received:2023-04-04 Published:2023-10-01
  • Corresponding author: Zhichao Chen
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陈志超, 张志伟, 蒋勰, 顾祖超, 蒋菁芸, 许婷婷. 带线锚钉结合缝线捆扎固定髌骨下极粉碎性骨折[J]. 中华关节外科杂志(电子版), 2023, 17(05): 732-735.

Zhichao Chen, Zhiwei Zhang, Xie Jiang, Zuchao Gu, Jingyun Jiang, Tingting Xu. Treatment of comminuted fracture of inferior pole of patella with suture anchor combined suture binding[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 732-735.

目的

探讨带线锚钉结合缝线捆扎固定髌骨下极粉碎性骨折的手术技术及临床疗效。

方法

选取2019年1月至2022年1月成都市第一人民医院经带线锚钉结合缝线捆扎缝合治疗的19例患者作为实验组，行钢丝垂直间断固定的20例患者作为对照组。对2组患者的术后膝关节活动度(ROM)、Bostman评分、膝前痛、骨愈合时间进行疗效评估比较。计量资料以采用t检验，计数资料使用卡方检验。

结果

实验组患者无骨不愈合及膝前痛发生，平均骨愈合时间为(2.5±0.5)个月，低于对照组的(3.2±0.7)个月(t＝3.577，P<0.05)。实验组患者末次随访时ROM为(131.7±5.6)°，高于对照组的(116.5±7.0)°(t＝7.481，P<0.05)。实验组患者Bostman评分平均为(27.3±2.1)分，高于对照组的(22.5±2.9)分(t＝5.922，P<0.05)。

结论

带线锚钉结合缝线捆扎缝合固定髌骨下极粉碎性骨折是一种简单、有效的手术方式，可以获得良好的临床疗效且无需二次手术取出内固定。

关键词: 髌骨, 缝合锚钉, 缝线, 骨折，粉碎性
Objective

To explore the surgical technique and clinical efficacy of suture anchor combined with suture binding for the fixation of comminuted fractures of the inferior pole of the patella.

Methods

A total of 19 patients treated with suture anchor and suture binding at Chengdu First People's Hospital from January 2019 to January 2022 were selected as the experimental group, while 20 patients treated with vertical intermittent steel wire fixation were selected as the control group. The postoperative range of motion(ROM) of knee joint, Bostman score, anterior knee pain, and bone healing time between two groups were evaluated and compared. The measurement data were analyzed by t test; counting data were analyzed by chi square test.

Results

No bone non-union or knee pain occurred in the experimental group; the average bone healing time was (2.5±0.5) months, which was shorter than (3.2±0.7) months of the control group(t=3.577, P<0.05). At the last follow-up, the average ROM of the experimental group patients was (131.7±5.6)°, which was larger than(116.5±7.0)°of the control group(t=7.481, P<0.05). The average Bostman score of the experimental group was(27.3±2.1), which was higher than(22.5±2.9)of the control group(t=5.922, P<0.05).

Conclusion

The combination of suture anchor and suture binding is a simple and effective surgical method for the fixation of comminuted fractures of the lower pole of the patella, which can achieve good clinical efficacy without the need for secondary surgical removal and internal fixation.

Key words: Patella, Suture anchors, Sutures, Fractures, comminuted
图1 带线锚钉结合缝线捆扎固定术中复位固定示意图。图A锚钉植入；图B锚钉缝线缝合；图C、D骨隧道示意图；图E所有缝线下面观；图F复位固定后效果图
Figure 1 Schematic diagram of intraoperative reduction and fixation using thread anchor and suture binding fixation. A is anchor nail implantation; B is anchor nail suture stitching; C and D are bone tunnel schematic diagrams in lateral and antero-posterior views; E is inferior view of all stitches; F is effect diagram after resetting and fixing
表1 一般资料比较
Table 1 Comparison of General Information
组别Groups 例数Number of cases 性别(男/女)Gender (male/female) 年龄[岁，(±s)]Age (year) 受伤原因(例)Reason for injury
车祸Car accident 摔倒跪地Fall on knees 暴力击打Violent hitting
实验组Experimental group 19 8/11 35±11 6 13 0
对照组Control group 20 10/10 37±18 10 9 1
统计值   χ2＝0.244 t＝0.390 χ2＝2.703
P值   >0.05 >0.05 >0.05
表2 两组观察指标比较(±s)
Table 2 Comparison of two groups of observation indicators
组别Groups 例数Number of cases 手术时间(min)Operative time 骨愈合时间(个月)Bone healing time (months) 膝关节屈曲范围(°)Range of knee flexion Bostman评分Bostman score
实验组Experimental group 19 52.4±6.0 2.5±0.5 131.7±5.6 27.3±2.1
对照组Control group 20 55.6±8.7 3.2±0.7 116.5±7.0 22.5±2.9
t值   1.327 3.577 7.481 5.922
P值   >0.05 0.001 <0.001 <0.001
图2 典型病例手术前后右膝关节正侧位X线影像。图A为术前右膝X线片，示右髌骨下极粉碎性骨折；图B为术后第1天膝右膝X线片，示带线锚钉结合缝线捆扎固定术后髌骨复位；图C为术后6周右膝X线片，示髌骨骨折线模糊，右膝屈曲良好
Figure 2 Anterio-posterior and lateral views of X-ray images of right knee before and after surgery. A is the image of right knee before surgery, showing comminuted fractures of patella at inferior pole; B is X-ray image of right knee joint on the first day after surgery, showing the patella fracture reduction with suture anchor and suture binding; C is X-ray image of right knee joint at six weeks after surgery, showing blurred fracture line and the flexion of knee
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