镜下与开放钛缆固定髌骨骨折比较  

Arthroscopic reduction and titanium cable fixation versus open counterpart for patellar fractures

作　　者：杜暠 王思成 侯俊叶 李广峰 尹志峰 张文薷 杨笑宇 李王 曹中华 DU Hao;WANG Sicheng;HOU Jun-ye;LI Guang-feng;YIN Zhi-feng;ZHANG Wen-ru;YANG Xiao-yu;LI Wang;CAO Zhong-hua(Department of Orthope-dics,Shanghai Hospital of Metallurgical Corporation of China(MCC),Shanghai 200941,China)

机构地区：[1]上海中冶医院骨科,上海200941

出　　处：《中国矫形外科杂志》2025年第1期25-31,共7页Orthopedic Journal of China

基　　金：上海市宝山区重点专科项目(编号:bszk-2023-a07);上海市宝山区科委课题项目(编号:2023-E-26);中国金属学会冶金安全与健康分会健康卫生科研项目(编号:jkws202330);上海中冶医院科研发展基金项目(编号:23-ZYKYA-12)。

摘　　要：[目的]比较关节镜下与传统开放复位钛缆内固定治疗髌骨骨折的临床疗效。[方法]回顾性分析2022年1月—2022年12月本科收治的闭合性单侧髌骨骨折59例患者的临床资料。根据医患沟通结果,31例采用镜下钛缆内固定(镜下组),28例采用开放复位内固定(开放组)。比较两组围手术期、随访及影像资料。[结果]所有患者均顺利完成手术,镜下组切口总长度[(3.5±0.3)cm vs(8.5±0.6)cm,P<0.001]、术中失血量[(73.5±16.4)ml vs(94.6±21.5)ml,P<0.001]、术中透视次数[(2.8±0.9)次vs(3.4±1.0)次,P=0.035]、住院时间[(4.3±1.5)d vs(8.3±2.1)d,P<0.001]均显著优于开放组。随访时间平均(15.3±4.4)个月,两组恢复完全负重活动时间的差异无统计学意义(P>0.05)。术后随时间推移,两组患者VAS评分、Kujala评分、Lysholm评分、膝伸-屈ROM均显著改善(P<0.05)。术后12周和末次随访时,镜下组的膝伸-屈ROM[(105.0±3.9)°vs(100.5±3.9)°,P<0.001;(117.9±4.8)°vs(112.3±4.4)°,P<0.001]显著优于开放组。影像方面,与术前相比,末次随访时两组关节面对合均显著改善(P<0.05),相应时间点,两组间关节面对合情况的差异均无统计学意义(P>0.05)。两组影像骨折愈合时间的差异均无统计学意义(P>0.05)。[结论]与开放复位内固定相比,关节镜下髌骨骨折复位,钛缆内固定具有安全性好、出血量小、手术时间短、切口小、住院时间短、功能恢复更好的优点。[Objective]To compare the clinical efficacy of arthroscopic reduction and titanium cable internal fixation versus traditional open counterpart for patellar fractures.[Methods]A retrospective study was conducted on 59 patients had closed unilateral patellar frac⁃tures treated surgically in our department from January 2022 to December 2022.According to doctor-patient communication,31 patients un⁃derwent arthroscopic reduction and titanium cable internal fixation(the arthroscopic group),while other 28 patients received open reduction and titanium cable internal fixation(the open group).The perioperative,follow-up and imaging data of the two groups were compared.[Re⁃sults]All the patients in both groups were successfully operated on.The arthroscopic group proved significantly superior to the open group in terms of total incision length[(3.5±0.3)cm vs(8.5±0.6)cm,P<0.001],intraoperative blood loss[(73.5±16.4)ml vs(94.6±21.5)ml,P<0.001],intraoperative fluoroscopy times[(2.8±0.9)times vs(3.4±1.0)times,P=0.035],hospital stay[(4.3±1.5)day vs(8.3±2.1)days,P<0.001].The mean follow-up period was of(15.3±4.4)months,and there was no significant difference in time to resume full weight-bearing activities be⁃tween the two groups(P>0.05).The VAS,Kujala and Lysholm scores,as well as knee extension-flexion range of motion(ROM)were signifi⁃cantly improved in both groups over time postoperatively(P<0.05).At 12 weeks and the last follow-up,the arthroscopic group was signifi⁃cantly better than the open group in terms of knee extension-flexion ROM[(105.0±3.9)°vs(100.5±3.9)°,P<0.001;(117.9±4.8)°vs(112.3±4.4)°,P<0.001].Regarding to imaging,the joint surface congruity was significantly improved in both groups at the last follow-up compared with that preoperatively(P<0.05).However,there were no statistically significant differences in the joint face congruity between the two groups at and corresponding time points(P>0.05),and fracture healing time between the two groups(P>0.05).[Conclusion]The arthroscop⁃ic red

关 键 词：关节镜 导向器 微创手术 钛缆内固定 髌骨骨折 

分 类 号：R683.42[医药卫生—骨科学]