Three-dimensional binding treatment for avulsion fractures of inferior pole of patella utilizing suture anchor_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Hongqing ¹ , LI Ningkai ¹ , LIU Meng ¹ , LIN Jiating ² , WANG Qiang ¹ ,  ZHANG Yinchang ¹

1. Department of Joint and Bone Surgery, the First Affiliated Hospital of Wannan Medical College, Wuhu Anhui, 241000, P. R. China;
2. Department of Stomatology, the First Affiliated Hospital of Wannan Medical College, Wuhu Anhui, 241000, P. R. China;

Corresponding author：

ZHANG Yinchang, Email: 879870162@qq.com

Keywords：

Inferior pole fracture of patella; double-pulley technique; suture anchor; three-dimensional binding; internal fixation

DOI：

10.7507/1002-1892.202409080

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Objective To explore the feasibility and effectiveness of suture anchor double-pulley technique combined with suture three-dimensional binding via bone tunnel technique for avulsion fractures of the inferior pole of the patella. Methods A clinical data of 38 patients with avulsion fractures of the inferior pole of the patella, who met the selective criteria and were admitted between September 2021 and April 2023, was retrospectively analyzed. The fractures were treated with suture anchor double-pulley technique combined with suture three-dimensional binding via bone tunnel technique in 18 cases (group A) and steel wire tension-band fixation in 20 cases (group B). There was no significant difference in terms of age, gender, cause of fracture, side of fracture, and disease duration between the two groups (P>0.05). The length of incision, operation time, occurrence of complications, the range of motion of knee joint, and Böstman score of knee joint at last follow-up were recorded. The fracture healing was evaluated through X-ray films and the time of fracture healing was recorded. Results All incisions healed by first intention. The length of incision was significantly shorter in group A than in group B (P<0.05). There was no significant difference in the operation time between the two groups (P>0.05). All patients were followed up for an average of 16.1 months (range, 12-24 months). X-ray films showed that all fractures healed and no significant difference in the healing time between the two groups (P>0.05). At last follow-up, the range of motion and Böstman score of the knee joint in group A were significantly better than those in group B (P<0.05). During follow-up, 1 patient (5.6%) in group A had one anchor mild prolapse and 3 patients (15.0%) occured internal fixation irritation in group B. But there was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion For the avulsion fractures of the inferior pole of the patella, the suture anchor double-pulley technique combined with suture three-dimensional binding via bone tunnel technique has advantages of reliable fixation, small incision, avoidance of secondary operation to remove internal fixator, and fewer complications, with definite effectiveness.

1.	宋世强, 郭兆明, 王晓明. 生物力学在髌骨骨折成伤机制鉴定中的应用. 中国法医学杂志, 2023, 38(3): 241-243.
2.	王伟斌, 韩欣攸, 扶青松, 等. 髌骨骨折内固定术中判断内外侧关节面复位质量的新透视方法. 中国修复重建外科杂志, 2024, 38(7): 836-841.
3.	张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
4.	刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
5.	左强, 吕天润, 方加虎, 等. 双线锚钉固定结合缝线张力带技术治疗老年髌骨下极骨折的临床疗效分析. 南京医科大学学报(自然科学版), 2023, 43(10): 1427-1431.
6.	Du B, Ma T, Bai H, et al. Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture. Front Bioeng Biotechnol, 2022, 10: 1010508. doi: 10.3389/fbioe.2022.1010508.
7.	Park YG, Choi S, Kim BS, et al. Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique. Ann Med Surg (Lond), 2022, 84: 104822. doi: 10.1016/j.amsu.2022.104822.
8.	Bhumiwat P, Fossum BW, Dey Hazra RO, et al. Treatment of unfixable inferior pole fractures of the patella using an all-suture internal fixation technique. Clin Orthop Surg, 2024, 16(1): 168-172.
9.	刘振, 刘军, 李小净, 等. 双缝线锚钉交替环抱固定髌骨下极骨折. 中国矫形外科杂志, 2023, 31(11): 1028-1031.
10.	付尧, 瞿晓宏, 房小文, 等. 双排锚钉缝线桥技术治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2023, 38(6): 626-629.
11.	Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
12.	袁建敏, 陶周善, 杨民, 等. 带线锚钉联合髌骨横向钻孔修复股四头肌腱骨腱结合部断裂. 中国骨伤, 2020, 33(1): 71-75.
13.	Zhou M, Jia X, Cao Z, et al. Treatment of inferior pole patella fracture using Krackow suturing combined with the suture bridge technique. Arch Orthop Trauma Surg, 2023, 143(6): 2973-2980.
14.	Chang C, Shih C, Kuan F, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
15.	Demirtaş Y, Katı Y A. A novel patella fracture fixation technique: finite element analysis. Arch Orthop Trauma Surg, 2023, 143(8): 5105-5115.
16.	王海鹏, 梁立卓, 王璞, 等. 髌骨下极骨折: 一种新的微创治疗方法及其临床疗效分析. 创伤外科杂志, 2022, 24(8): 596-601.
17.	谢美明, 廖冬发, 龚凯, 等. 多向三维钢丝环套固定治疗髌骨下极撕脱骨折疗效分析. 中国修复重建外科杂志, 2021, 35(2): 183-187.
18.	施林军, 吴聪聪. 双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折. 中国骨伤, 2023, 36(3): 247-250.
19.	张欣, 袁建敏, 丁国正, 等. 带线锚钉联合髌骨纵向钻孔Nice结捆扎技术治疗髌骨下极骨折. 中国修复重建外科杂志, 2023, 37(6): 675-680.
20.	汤俊峰, 孙良业, 凤晓翔, 等. 髌骨下极粉碎性骨折两种内固定的比较. 中国矫形外科杂志, 2024, 32(14): 1279-1284.

1. 宋世强, 郭兆明, 王晓明. 生物力学在髌骨骨折成伤机制鉴定中的应用. 中国法医学杂志, 2023, 38(3): 241-243.
2. 王伟斌, 韩欣攸, 扶青松, 等. 髌骨骨折内固定术中判断内外侧关节面复位质量的新透视方法. 中国修复重建外科杂志, 2024, 38(7): 836-841.
3. 张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
4. 刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
5. 左强, 吕天润, 方加虎, 等. 双线锚钉固定结合缝线张力带技术治疗老年髌骨下极骨折的临床疗效分析. 南京医科大学学报(自然科学版), 2023, 43(10): 1427-1431.
6. Du B, Ma T, Bai H, et al. Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture. Front Bioeng Biotechnol, 2022, 10: 1010508. doi: 10.3389/fbioe.2022.1010508.
7. Park YG, Choi S, Kim BS, et al. Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique. Ann Med Surg (Lond), 2022, 84: 104822. doi: 10.1016/j.amsu.2022.104822.
8. Bhumiwat P, Fossum BW, Dey Hazra RO, et al. Treatment of unfixable inferior pole fractures of the patella using an all-suture internal fixation technique. Clin Orthop Surg, 2024, 16(1): 168-172.
9. 刘振, 刘军, 李小净, 等. 双缝线锚钉交替环抱固定髌骨下极骨折. 中国矫形外科杂志, 2023, 31(11): 1028-1031.
10. 付尧, 瞿晓宏, 房小文, 等. 双排锚钉缝线桥技术治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2023, 38(6): 626-629.
11. Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
12. 袁建敏, 陶周善, 杨民, 等. 带线锚钉联合髌骨横向钻孔修复股四头肌腱骨腱结合部断裂. 中国骨伤, 2020, 33(1): 71-75.
13. Zhou M, Jia X, Cao Z, et al. Treatment of inferior pole patella fracture using Krackow suturing combined with the suture bridge technique. Arch Orthop Trauma Surg, 2023, 143(6): 2973-2980.
14. Chang C, Shih C, Kuan F, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
15. Demirtaş Y, Katı Y A. A novel patella fracture fixation technique: finite element analysis. Arch Orthop Trauma Surg, 2023, 143(8): 5105-5115.
16. 王海鹏, 梁立卓, 王璞, 等. 髌骨下极骨折: 一种新的微创治疗方法及其临床疗效分析. 创伤外科杂志, 2022, 24(8): 596-601.
17. 谢美明, 廖冬发, 龚凯, 等. 多向三维钢丝环套固定治疗髌骨下极撕脱骨折疗效分析. 中国修复重建外科杂志, 2021, 35(2): 183-187.
18. 施林军, 吴聪聪. 双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折. 中国骨伤, 2023, 36(3): 247-250.
19. 张欣, 袁建敏, 丁国正, 等. 带线锚钉联合髌骨纵向钻孔Nice结捆扎技术治疗髌骨下极骨折. 中国修复重建外科杂志, 2023, 37(6): 675-680.
20. 汤俊峰, 孙良业, 凤晓翔, 等. 髌骨下极粉碎性骨折两种内固定的比较. 中国矫形外科杂志, 2024, 32(14): 1279-1284.

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