可吸收软骨钉联合带线锚钉对髌骨脱位合并骨软骨骨折的临床疗效

Therapeutic effect of bioabsorbable cartilage nails combined with suture anchors for patellar dislocation complicated by osteochondral fracture

摘要:

目的 评估关节镜下应用可吸收软骨钉联合带线锚钉治疗创伤性髌骨脱位合并骨软骨骨折的临床疗效。方法 前瞻性选取2020年1月—2023年1月浙江中医药大学附属江南医院收治的96例创伤性髌骨脱位合并骨软骨骨折患者作为研究对象。采用随机数字表法将患者分为研究组和对照组，每组48例。对照组患者接受治疗关节镜下带线锚钉治疗，研究组患者接受关节镜下可吸收软骨钉联合带线锚钉治疗。患者术后随访，Bostman髌骨骨折功能评分标准评判治疗有效率、评估术前术后膝关节功能［国际膝关节文献委员会（IKDC）评分、Lysholm膝关节评分、视觉模拟评分（VAS）］、膝关节活动情况（单腿跳远测试及关节活动范围）、关节液内炎症因子［白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）］水平及并发症等。结果 研究组患者治疗有效率高于对照组（P <0.05）。研究组术后IKDC评分、Lysholm评分均高于对照组（P <0.05），VAS评分低于对照组（P <0.05）。研究组手术前后IKDC评分、Lysholm评分、VAS评分的差值均大于对照组（P <0.05）。研究组术后单腿跳远距离和屈膝角度均高于对照组（P <0.05）。研究组治疗后IL-1β、TNF-α均低于对照组（P <0.05）。研究组治疗前后IL-1β、TNF-α的差值均大于对照组（P <0.05）。研究组患者并发症总发生率低于对照组（P <0.05）。结论 关节镜下可吸收软骨钉联合带线锚钉治疗创伤性髌骨脱位合并骨软骨骨折在本研究中显示出了良好的临床效果。该方法不仅可以有效提高髌骨稳定性，减少复发风险，而且大多数患者能够在较短的时间内恢复良好的膝关节功能，且并发症发生率低。

Abstract:

Objective To evaluate the therapeutic effect of arthroscopic treatment using bioabsorbable cartilage nails combined with suture anchors for traumatic patellar dislocation complicated by osteochondral fracture.Methods We prospectively selected 96 patients with traumatic patellar dislocation complicated by osteochondral fracture, who were treated at Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2020 to January 2023. Patients were randomly divided into the study group (n = 48) and the control group (n = 48). The control group received arthroscopic surgery with suture anchors, while the study group underwent arthroscopic surgery with bioabsorbable cartilage nails combined with suture anchors. Patients were followed up postoperatively. The treatment efficacy was evaluated according to the Bostman scoring system for patellar fractures. Knee joint function was assessed before and after surgery using the International Knee Documentation Committee (IKDC) score, the Lysholm knee score, and the visual analog scale (VAS). Knee joint performance was further evaluated by the single-leg hop test and range of motion. Levels of inflammatory cytokines in synovial fluid, including interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), were measured. Postoperative complications were also recorded.Results The effective rate was higher in the study group compared to the control group (P < 0.05). Postoperative IKDC scores and Lysholm knee scores were higher in the study group than in the control group (P < 0.05), while VAS scores were lower in the study group (P < 0.05). The differences in IKDC scores, Lysholm knee scores, and VAS scores before and after surgery were greater in the study group than in the control group (P < 0.05). Postoperative single-leg hop distance and knee flexion angle were greater in the study group compared to the control group (P < 0.05). Levels of IL-1β and TNF-α after treatment were lower in the observation group than in the control group (P < 0.05). The differences in IL-1β and TNF-α levels before and after treatment were greater in the observation group than in the control group (P < 0.05). The overall incidence of complications was lower in the study group than in the control group (P < 0.05).Conclusion The arthroscopic treatment using bioabsorbable cartilage nails combined with suture anchors for traumatic patellar dislocation complicated by osteochondral fractures demonstrates favorable clinical efficacy. This approach not only effectively improves patellar stability and reduces the risk of recurrence, but also enables most patients to achieve good knee joint function within a relatively short period, with a low incidence of complications.