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Title: [Comparative study on the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures].
Author: Zhang J, Wan S, Zhong Z, Zeng J, Wu C, Tan L, Lin X.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Aug 15; 35(8):994-999. PubMed ID: 34387428.
Abstract:
OBJECTIVE: To compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures. METHODS: Between January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups ( P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups. RESULTS: The operation time in group A was significantly less than that in group B ( t=-4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups ( P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference ( t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant ( Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) ( χ ²=6.611, P=0.010). CONCLUSION: Compared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint. 目的: 比较改良与传统克氏针张力带固定治疗髌骨 C 型骨折的疗效。. 方法: 2017 年 1 月—2019 年 1 月，采用改良克氏针张力带固定治疗 26 例髌骨 C 型骨折患者（A 组），与同期采用传统克氏针张力带固定治疗的 24 例患者（B 组）进行比较。两组患者性别、年龄、致伤原因、受伤至手术时间、骨折侧别及类型等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组手术时间、术中出血量、术后 1 d 及 3 d 疼痛视觉模拟评分（VAS）、骨折愈合时间以及克氏针激惹皮肤、内固定失效、骨折复位丢失等并发症发生情况，采用 Lysholm 评分评定膝关节功能。. 结果: A 组手术时间较 B 组缩短，差异有统计学意义（ t=−4.742， P=0.000）；两组术中出血量以及术后 1、3 d VAS 评分比较，差异均无统计学意义（ P>0.05）。两组切口均Ⅰ期愈合。患者均获随访，随访时间 8～15 个月，平均 11 个月。A 组患者骨折愈合时间（3.3±0.6）个月，B 组（3.2±0.6）个月，两组差异无统计学意义（ t=0.589， P=0.559）。两组骨折愈合后均取出内固定物。末次随访时，膝关节功能根据 Lysholm 评分标准评定，A 组获优 15 例、良 8 例、可 3 例，优良率 88.5%；B 组获优 8 例、良 7 例、可 7 例、差 2 例，优良率 62.5%；两组比较差异有统计学意义（ Z=2.828， P=0.005）。末次随访时，A 组均无克氏针激惹皮肤发生、B 组发生 3 例；X 线片复查示 A 组 5 例内固定失效、无骨折复位丢失，B 组 9 例内固定失效、1 例骨折复位丢失。A 组并发症发生率为 19.2%（5/26），低于 B 组的 54.2%（13/24），差异有统计学意义（ χ ²=6.611， P=0.010）。. 结论: 与传统克氏针张力带固定相比，改良克氏针张力带固定治疗髌骨 C 型骨折能缩短手术时间、降低并发症发生率，有利于膝关节功能恢复。.

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