痛性Saupe Ⅲ型二分髌骨空心钉固定与切除的比较  

Open reduction and cannulated screw fixation versus arthroscopic resection of painful Saupe type Ⅲ bipartite patella

作　　者：林三福[1] 巫海鹏 王文怀[1] 陈守勃[1] 郑煜晖[1] San-fu;WU Hai-peng;WANG Wen-huai;CHEN Shou-bo;ZHENG Yu-hui(Department of Orthopaedics,The Second Affiliated Hospital,Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院骨科,福建泉州362000

出　　处：《中国矫形外科杂志》2023年第19期1767-1772,共6页Orthopedic Journal of China

基　　金：福建省教育厅中青年教师教育科研项目(编号:JT180201)。

摘　　要：[目的]比较空心钉固定与切除治疗痛性SaupeⅢ型二分髌骨的临床疗效。[方法]回顾性分析2008年1月-2020年1月因二分髌骨就诊本院治疗的19例患者的临床资料,根据医患沟通结果,10例行空心钉固定(固定组),9例采用关节镜行副髌骨摘除(切除组)。比较两组围手术期、随访及影像资料。[结果]固定组的切口长度显著大于切除组[(3.5±0.4) cm vs(1.8±0.3) cm, P<0.05],但前者在术后5 d VAS评分[(2.6±0.2) vs (3.6±0.1), P<0.05]和下地行走时间[(3.5±1.3) d vs (6.7±1.0) d, P<0.05]均显著优于后者(P<0.05),两组切口愈合情况及住院时间的差异均无统计学意义(P>0.05)。随访时间平均(36.1±2.5)个月,随时间推移,两组VAS评分显著减少(P<0.05),膝关节Kujala评分、Hungerford评分、膝伸-屈ROM均显著增加(P<0.05)。术前两组间上述指标的差异均无统计学意义(P>0.05),术后12个月,固定组在VAS评分[(1.6±0.5) vs (2.9±0.8), P<0.05]、Kujala评分[(92.1±3.2) vs (85.8±4.4), P<0.05]、Hungerford评分[(95.1±4.3) vs (87.5±5.4), P<0.05]及膝伸-屈ROM [(139.4±4.7)°vs(131.6±3.3)°, P<0.05]均显著优于切除组(P<0.05)。影像方面,与术前相比,术后6、12个月,两组髌股K-L评级和Insall指数均无显著变化(P>0.05),相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。[结论]采用空心钉固定治疗痛性二分髌骨,具有创伤小、直视下复位和固定可靠的优点,近期临床结果优于镜下切除术。[Objective]To compare the clinical efficacy of open reduction and cannulated screw fixation versus arthroscopic resection of painful Saupe type Ⅲ bipartite patella.[Methods]A retrospective study was conducted on 19 patients who receive surgical treatment for painful bipartite patella in our hospital from January 2008 to January 2020.According to doctor-patient communication,10 patients under-went open reduction and cannulated screw fixation(the fixation group),while the remaining 9 patients underwent arthroscopic resection(the resection group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]Although the fixation group had significantly longer incision than the resection group[(3.5±0.4)cm vs(1.8±0.3)cm,P<0.05],the former proved significantly superior to the latter in terms of pain VAS score 5 days after operation[(2.6±0.2)vs(3.6±0.1),P<0.05]and ambulation time[(3.5±1.3)days vs(6.7±1.0)days,P<0.05],despite of insignificant differences in incision healing and hospital stay between the two groups(P>0.05).With time of the fol-low-up lasted for(36.1±2.5)months on a mean,the pain VAS score significantly reduced(P<0.05),whereas Kujala and Hungerford scores,as well as knee extension-flexion ROM significantly increased in both groups(P<0.05).There were no statistically significant differences in the above indexes between the two groups before operation(P>0.05),but the fixation group was significantly better than the resection group in terms of VAS score[(1.6±0.5)vs(2.9±0.8),P<0.05],Kujala score[(92.1±3.2)vs(85.8±4.4),P<0.05],Hungerford score(95.1±4.3)vs(87.5±5.4),P<0.05]and knee ROM[(139.4±4.7)°vs(131.6±3.3)°,P<0.05]12 months postoperatively.Regarding to imaging,the patello-femoral K-L classification and Insall index remained unchanged significantly in both groups at 6 and 12 months after surgery compared with those preoperatively(P>0.05),which were not statistically significant between the two groups at any time points correspondingly(P>0.05).[Conclusion]The open re

关 键 词：痛性二分髌骨 内固定 空心螺钉 切除 关节镜 

分 类 号：R687[医药卫生—骨科学]