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Objective:To compare the clinical effect of hollow screw tension band internal fixation and Kirschner wire tension band internal fixation for patellar fracture, so as to provide reference for clinical operation.Methods:A retrospective case-control study was conducted to analyze the clinical data of 82 patients with transverse patellar fracture admitted to the Department of Orthopedics of Linxi Hospital of Kailuan general hospital and the Department of orthopedics of Tangshan Central Hospital from May 2016 to October 2018.According to different operation methods, they were divided into Kirschner wire group (44 cases) and cannulated screw group (38 cases). The Kirschner wire group was treated with Kirschner wire tension band internal fixation, and the hollow screw group was treated with cannulated screw tension band internal fixation. The operation conditions, postoperative complications and postoperative knee function recovery of the two groups were compared.Results:The operation time of hollow screw group was significantly longer than that of Kirschner wire group((68.25±10.81) min vs.(59.72±12.32) min, t=3.31, P<0.05). Fracture healing time of hollow screw group was significantly shorter than that of Kirschner wire group((3.12±0.40) month vs.(3.68±0.45) month, t=5.91, P<0.05). B?stmanscores of the two groups increased significantly with time( Fintra-group=74.69, P<0.05). The B?stmanscore of cannulated screw group was significantly higher than that of Kirschner wire group ( Finteraction=4.87, P<0.05). The B?stmanscore of hollow screw group was significantly higher than that of Kirschner wire group( Finter-group=7.52, P<0.05). VAS scores in both decreased significantly with time( Finter-group=86.24, P<0.05). The decreasing of visual analogue scale (VAS) score in hollow screw group was significantly higher than that in Kirschner wire group( Finteraction=6.62, P<0.05). The VAS score in hollow screw group was significantly lower than that in Kirschner wire group ( Finter-group=7.74, P<0.05). The postoperative complications were 20.5% (9/44) in Kirschner wire group and 5.3% (2/38) in hollow screw group.The incidence of adverse reactions in hollow screw group was lower than that in Kirschner wire group (χ 2=4.05, P<0.05). The excellent and good rates of Kirschner wire group and cannulated screw group were 86.4% (38/44) and 94.7% (36/38), respectively, with no significant difference (χ 2=0.51, P>0.05). Conclusion:The results show that the two methods have the same effect on patella fracture, but the hollow screw tension band internal fixation has less trauma and less complications, which is conducive to the recovery of knee joint function.
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Objective:To investigate the clinical effect of arthroscopic minimally invasive Kirschner wire tension band internal fixation in the treatment of transverse patellar fracture.Methods:From March 2016 to March 2018, 108 patients with transverse patellar fracture admitted to the Department of orthopedics, Linxi hospital, Kailuan general hospital, Hebei Province were analyzed retrospectively.According to the different operation methods, the patients were divided into arthroscopic group (68 cases) and control group (40 cases). The patients in the arthroscopic group were treated with arthroscopic minimally invasive Kirschner wire tension band internal fixation, and the patients in control group were treated with open reduction and Kirschner wire tension band internal fixation.The operation condition, clinical efficacy, Lysholm score and visual analogue scale(VAS) score were compared between the two groups.Results:The incision length((3.5±0.8) cm) of arthroscopic group was shorter than that of control group((13.7±2.2) cm), the amount of intraoperative bleeding ((47.4±12.5) ml) was significantly less than that of control group ((86.9±14.7) ml), and the length of hospitalization((11.8±2.6) d) and fracture healing time ((11.5±2.4) weeks)were significantly less than those in control group ((15.8±3.0) d, (15.7±2.8) weeks), the difference was statistically significant( t value were 34.63, 14.85, 7.29, 8.25; all P<0.05). The Lysholm score of two groups increased significantly with time( Fintra-group=87.53, P<0.05). The increasing of Lysholm score in arthroscopic group was significantly higher than that in control group( Finteraction=7.64, P<0.05). The overall level of Lysholm in arthroscopic group was significantly higher than that of control group( Finter-group=11.42, P<0.05). The VAS score of two groups decreased significantly with time( Fintra-group=76.47, P<0.05). The decreased of VAS score in arthroscopic group was significantly higher than that in control group( Finteraction=9.96, P<0.05). The overall level of VASin arthroscopic group was significantly lower than that of control group( Finter-group=10.38, P<0.05). Conclusion:Arthroscopic minimally invasive Kirschner wire tension band internal fixation for the treatment of transverse patellar fracture has better efficacy and safety, less injury, less pain after operation.
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Objective To investigate the clinical effect of arthroscopy minimally invasive Kirschner wire tension band internal fixation combined with lower limb feedback training for patellar fracture.Methods Fifty-eight cases of patellar fracture who received arthroscopy minimally invasive Kirschner tension band internal fixation from March 2016 to April 2018 in Linxi Hospital,Kailuan General Hospital were included in this study.All cases were divided into control group (32 cases) and observation group (26 cases) according to the different rehabilitation methods.Control group received routine rehabilitation,observation group received intelligent feedback system of the lower limbs based on the control group.The recovery of joint function was compared between two groups.Results The clinical efficacy of the observation group was excellent (18 cases),good (6 Cases),and medium (2 cases),the excellent and good rate was 92.30％ (24/ 26).In the control group,the clinical effect was excellent (19 cases),good (9 cases),and medium (4 cases).The excellent and good rate was 87.50％ (28/32).There was no significant difference in clinical efficacy (z =0.80,P＞ 0.05) and excellent and good rate (x2 =0.36,P＞ 0.05) between two groups after 6 months follow-ups.The scores and total scores of B(o)stman patellar fracture function before treatment in observation group were pain (3.3 ± 0.8),Knee range of motion (3.2 ± 0.7),work (1.8 ± 0.3),muscular atrophy (1.8±0.2),auxiliaries (2.9 ± 0.6),effusion (1.2 ± 0.4),giving way (0.3 ± 0.2),climb stairs (0.3 ±0.2) andtotal score (15.0 ±2.2) respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in observation group were pain (5.7 ± 0.4),Knee range of motion (5.8 ± 0.2),work (3.6 ±0.5),muscular atrophy (3.5 ± 0.6),auxiliaries (3.7 ± 0.4),effusion (1.8 ± 0.3),giving way (1.7 ±0.4),climb stairs (1.7 ± 0.5) and total score (28.3 ± 1.6) respectively.The B(o)stman patellar fracture functional score in observation group increased significantly (t =14.62,19.15,16.47,14.78,6.96,7.18,17.26,14.16,26.30,P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture function before treatment in control group werepain (3.4 ± 0.6),Knee range of motion (3.1 ± 0.6),work (1.9 ± 0.4),muscular atrophy(1.7 ±0.3),auxiliaries (2.8 ±0.5),effusion(1.1 ±0.3),giving way(0.4±0.2),climb stairs (0.4 ±0.2) andtotal score (14.8 ±2.3),respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in control group were pain(5.2±0.6),Knee range of motion(4.9 ±0.7),work(3.1 ±0.6),muscular atrophy (2.5 ± 0.5),auxiliaries (3.2 ± 0.4),effusion (1.3 ± 0.4),giving way (1.3±0.3),climb stairs (1.2 ± 0.4) and total score (22.7 ± 2.5),respectively.The functional scores of B(o)stman patellar fracture in control group were significantly increased (t =13.26,12.44,10.16,8.17,3.38,3.22,15.14,11.31,14.13,all P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture in observation group after treatment were significantly higher than those in control group (t =3.64,6.34,3.39,6.93,4.73,5.28,4.35,4.23,9.89,P ＜ 0.05).In observation group,the range of knee joint activity at different time were before operation (30.2 ± 6.1) °,2 weeks after operation (85.6 ± 6.8) °,4 weeks after operation (100.6± 7.5) °,6 weeks after operation (118.5 ± 8.3) °,8 weeks after operation (138.9 ± 8.2) °,respectively.In control group,the range of knee joint activity at different time werebefore operation (29.3 ±7.2) °,2 weeks after operation (74.8 ± 6.9) °,4 weeks after operation (92.8 ± 7.8) °,6 weeks after operation(102.8 ± 9.4) °,8 weeks after operation (121.1 ± 7.3) °,respectively.The range of knee joint activity of two groups were significantly increased with the duration of treatment,Fgroup =124.58,P ＜0.05.The increases of range of knee joint activity in observation group was significantly higher than that in control group,Fintersecrion =11.78,P＜0.05.The overall levels of range of knee joint activity in observation group were significantly higher than that of control group,and Fbetween =36.27,P＜ 0.05.The KSS scores of in observation group werebefore operation (40.5 ± 8.8),2 weeks after operation (66.4 ± 9.0),4 weeks after operation(76.8±9.1),6 weeks after operation (83.4 ±9.5) and 8 weeks after operation (89.4 ± 8.1),respectively.The KSS scores in control group at different time were before operation(38.9 ±9.2),2 weeks after operation (60.1 ± 8.3),4 weeks after operation (70.4± 8.2),6 weeks after operation (77.6± 7.3) and 8 weeks after operation(82.5±8.6) respectively.The KSS score of two groups were significantly increased with the duration of treatment,Fgroup =84.32,P＜0.05.The increases of KSS score in observation group were significantly higher than that in control group,Fintersecrion =8.94,P＜0.05.The overall levels of range of KSS score in observation group were significantly higher than that of control group,and Fbetween =28.52,P ＜0.05.Conclusion The application of lower limb feedback training system after arthroscopic minimally invasive Kirschner wire tension band fixation can promote the recovery of knee joint function in patients with patellar fracture.
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Objective To investigate the clinical effect of minimally invasive Kirschner wire tension band internal fixation under arthroscopy in the treatment of patellar fracture.Methods From March 2016 to April 2018,ninety patients with patellar fracture admitted to the Department of Orthopedics,Lin Xi Hospital of Kailuan General Hospital were divided into minimally invasive group (58 cases) and control group (32 cases) according to different operative methods.The control group received traditional open reduction and Kirschner wire tension band internal fixation.Minimally invasive group received arthroscopic minimally invasive Kirschner wire tension band internal fixation.The operation status,joint function recovery and VAS scores were compared between the two groups.Results The amount of blood loss,hospitalization time and fracture healing time in minimally invasive group were significantly less than those in control group ((48.7 ±13.6) mlvs.(85.5±12.3) ml,t=12.7,P＜0.05;(12.5±2.8) d vs.(14.8±1.4) d,t=4.35,P＜0.05;(11.2± 1.3) weeks vs.(15.4± 2.2) weeks,t =11.40,P＜0.05).After 6 months of follow-up,the VAS score of the two groups decreased with the time (the VAS score of the minimally invasive group decreased from (7.2±1.1) points preoperatively to (0.9±0.2) points at 6 months postoperatively,and that of the control group decreased from (7.3±1.2) points preoperatively to (1.1±0.3) at 6 months postoperatively).There was a significant difference between the two groups (F group =77.87,P＜0.05).The VAS score of both groups decreased with time (Ft ime=263.47,P＜0.05).The decrease of VAS score in the minimally invasive group was significantly larger than that in the control group (F interaction =28.63,P＜0.05).Conclusion Arthroscopic minimally invasive Kirschner wire tension band internal fixation for patellar fracture has better clinical effect and less trauma.
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Objective To explore the clinical effect of proprioceptive training on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.Methods Fifty-eight patients with minimally invasive Kirschner wire tension band internal fixation under arthroscopy in department of orthopedics,Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2018 were selected as research objects,and were divided into experimental group and conventional group according to digital lottery,Twenty-nine cases in each group.The conventional group received conventional rehabilitation therapy such as joint range of motion (ROM) training,joint mobilization technique,muscle strength training,weight-bearing standing and ambulation training,The experimental group added proprioception training on the basis of the conventional group.The affected knee active range of motion (AROM),Lysholm knee scoring scale (LKSS),Berg balance scale (BBS) score and modified Barthel index (MBI) score before treatment and after 2 months of treatment between the two groups were observed and compared.According to the LKSS scoring system,the effect of knee function rehabilitation was evaluated.Results After 2 months of treatment,the active range of motion of the knee joint in the experimental group ((120.3± 17.1) °) was better than that in the conventional group ((100.4± 17.5) °),with significant difference (t =4.380,P =0.000);the LYSHOLM knee joint function score in the experimental group ((93.2 ± 5.3) points) was higher than that in the conventional group ((80.6 ± 7.7) points),with significant difference (t=7.259,P=0.000);the score of BERG balance scale ((52.4±1.6) points vs.(43.7±2.8)points),the difference was significant (t =14.528,P =0.000);the score of improved BARTHEL index ((92.5± 3.1) points vs.(85.6± 2.2) points),the difference was significant (t =9.775,P=0.000).The excellent and good rate of knee joint function in the experimental group was 93.10％ (27/29),which was significantly higher than 72.41％ (21/29) in the conventional group.There was significant difference between the two groups (Z =-2.390,P =0.017).Conclusion The proprioceptive training has a remarkable effect on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.It can significantly improve the range of motion,joint stability and motion control ability of the affected knee,and improve the daily living ability of the patients.