Objective To compare the long-term effectiveness of patellar denervation by electrotomy combined with patellar replacement and patellar denervation by electrotomy alone in primary total knee arthroplasty (TKA). Methods A retrospective analysis was conducted on the clinical data of 30 patients treated with primary TKA of both knees between July 2013 and March 2015 who met the selection criteria. There were 11 males and 19 females, aged 56-79 years, with an average age of 67.6 years. One knee was randomly selected for patellar denervation by electrotomy combined with patellar replacement during TKA (combined group), while the other knee was treated with patellar denervation by electrotomy alone (control group). All patients adopted the same type of total knee prosthesis. After surgery, the patients were followed up regularly, and the occurrence of complications was recorded. The functions of the knee and patella were evaluated using the Knee Society Score (KSS) and Feller score, respectively. The position of the prosthesis, patella trajectory, and prosthesis loosening and wear were observed by imaging examination. Results All 30 patients were followed up 81.4-103.5 months, with an average of 90.4 months. The patellar thickness of the combined group ranged from 21 to 26 mm, with an average of 23.0 mm. The position of the prosthesis and patella trajectory in the combined group and the control group were good, without obvious loosening or wear. After operation, 2 sides (6.7%) in the combined group and 3 sides (10.0%) in the control group presented joint adhesion and poor activities. No complication such as lower limb deep vein thrombosis, aseptic fractures, and infections around the prosthesis occurred in both groups. At last follow-up, the KSS clinical score, KSS function score, and Feller score showed no significant difference between the two groups (P>0.05). According to the KSS score, 24 patients (80.0%) had no obvious preference for patellar denervation combined with patellar replacement, 3 patients (10.0%) preferred patellar replacement combined with patellar denervation, and 3 patients (10.0%) preferred no patellar replacement. Anterior knee pain occurred in 6 sides (20.0%) of both groups. Conclusion There is no significant difference in the long-term effectiveness between patellar denervation combined with patellar replacement and patellar denervation alone conducted in patients with knee osteoarthritis undergoing primary TKA.
Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.
目的:探讨带线锚钉治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的疗效。方法:自2003年9月至2008年7月共收治28例急性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤患者。对28例患者均采用开放手术下带线锚钉固定髌骨骨折及修复内侧髌股韧带损伤。术后1年进行术后的髌骨骨折Levack功能评分。结果:所有患者术后随访时间12~30个月,平均(16±3.50)个月。术后1年的髌骨骨折Levack功能评分标准优23例,可3例,差2例,优秀率达82.14%。无再次髌骨脱位或伴脱位患者。结论:开放手术下带线锚钉治疗对髌骨骨折固定及内侧髌股韧带修复可靠,是治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的有效方法。
Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
Objective To analyze the reasons for internal fixation failure after internal fixation of nickel-titanium memory alloy patella claw for patella fracture, and to explore the countermeasures. Methods The clinical data of patients with patellar fracture treated by internal fixation of nickel-titanium memory alloy patella claw in the Second Orthopedic Ward of Chongqing Orthopedic Hospital of Traditional Chinese Medicine from May 2015 to April 2020 were analyzed retrospectively. Patients with postoperative internal fixation failure were identified. The reasons for internal fixation failure were analyzed. Results A total of 436 patients were included. Internal fixation failure occurred in 10 patients. There were 6 cases (1.38%) of patellar claw detachment, and 4 cases of simple fracture block displacement witharticular surface displacement≥2 mm (0.92%). Internal fixation failure occurred 4 to 48 days postoperatively, with an average of (18.20±10.86)days. The analysis showed that the reason for internal fixation failure in 4 patients was improper early postoperative functional exercise. The reason for 3 patients was that the auxiliary internal fixation was not selected. The reason for 2 patients was that the size of the patellar claw was too small. The reason for 1 patient was the improper fixation of the auxiliary internal fixation. Conclusion The failure of internal fixation after patella fracture with nickel-titanium memory alloy patella claw is mainly related to whether the model of the patella claw is appropriate, whether the auxiliary internal fixation is selected, whether the auxiliary internal fixation is properly fixed, and whether the early postoperative functional exercise is appropriate.
Objective To investigate the clinical effect of chitosan in prevention of knee dysfunction due to adhesion after operation for patellar fracture. Methods From March to October 1999, 40 cases of patellar fracturewere treated by internal fixation, with intraarticular injection of 2% chitosan in only 24 cases after fixation and with no chitosan injection in 16 cases(control group). The function of the knee joint, including extension and flexion, was evaluated 1month and 1 year after operation respectively. Results One month after operation, the knees with chitosan injection could actively move in the average range of 104°±23°, and the knees in the control group could move in the average range of72°±16°, which showed significant difference between two groups(P＜0.01); 1 year after operation, the range of movement of the knees with injection was 165°±38° on average, and that of the knees in the control group was 110°± 31°, which also indicated significant difference between two groups (P＜0.05). Conclusion Medical chitosan could effectively prevent or reduce the post-operative adhesion of knee joint after patellar operation.
ObjectiveTo investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). MethodsBetween June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. ResultsAll incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation (P<0.05). ConclusionDDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.