关节镜辅助下微创克氏针张力带内固定对髌骨骨折患者骨代谢和体液免疫功能的影响

Effect of minimally invasive Kirschner wire tension band internal fixation assisted by arthroscope on bone metabolism and humoral immune function in patients with patella fracture

摘要:

目的 观察关节镜辅助下微创克氏针张力带内固定对髌骨骨折患者骨代谢和体液免疫功能的影响。方法 选取2017年3月—2019年8月该院髌骨骨折患者61例，以随机数字表法分为关节镜组（n = 31）和传统组（n = 30）。传统组行传统切开复位克氏针张力带内固定，关节镜组行关节镜辅助下微创克氏针张力带内固定。比较两组患者手术情况、并发症发生率、术前、术后1 d和术后3 d血清体液免疫功能［免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）］以及术前、术后2周和术后1个月骨代谢指标［抗酒石酸酸性磷酸酶-5b（TRAP-5b）、骨特异性碱性磷酸酶（BAP）和骨钙素（OCN）］水平。术后随访6个月，统计两组患者术前、术后3个月和术后6个月膝关节功能评分（KSS）、视觉模拟评分（VAS）及术后6个月膝关节活动范围优良率。结果 关节镜组术中出血量较传统组低，住院时间和骨折愈合时间较传统组短（P < 0.05）；两组患者术后1和3 d血清IgG、IgM和IgA水平较术前下降，但关节镜组高于传统组（P < 0.05）；两组患者术后2周和术后1个月血清TRAP-5b水平较术前降低，且关节镜组低于传统组，血清BAP和OCN水平较术前增高，且关节镜组高于传统组（P < 0.05）；术后随访6个月，无失访病例，两组患者术后3和6个月KSS评分较术前提高，且关节镜组高于传统组，VAS评分较术前降低，且关节镜组低于传统组（P < 0.05）；关节镜组术后6个月膝关节活动范围优良率90.32%，高于传统组的70.00%（P < 0.05）。结论 关节镜辅助下微创克氏针张力带内固定治疗髌骨骨折，能有效减少术中出血量，减轻体液免疫功能损害，缩短住院时间，促进骨折愈合，减轻疼痛程度，提高膝关节功能及活动范围。

Abstract:

Objective To observe the effect of minimally invasive Kirschner wire tension band internal fixation assisted by arthroscopy on bone metabolism and humoral immune function in patients with patella fractures.Methods Sixty-one patients with patella fractures from March 2017 to August 2019 were selected and divided into arthroscopy group (n = 31) and traditional group (n = 30) by random number table method. The traditional group underwent traditional open reduction Kirschner wire tension band internal fixation, and the arthroscopic group underwent arthroscopic-assisted minimally invasive Kirschner wire tension band internal fixation. The operation conditions and complications, serum humoral immune function [immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM)] before operation, 1 day and 3 days after operation, bone metabolic indexes [tartrate-resistant acid phosphatase-5b (TRAP-5b), bone-specific alkaline phosphatase (BAP) and osteocalcin (OCN)] levels before operation, 2 weeks and 1 month after operation of the two groups were compared. After 6 months of follow-up, the knee function score (KSS), visual analogue scale (VAS) and knee range of motion of the two groups before operation, 3 months and 6 months after operation and the excellent and good rate of knee joint range of motion after 6 months were counted.Results The intraoperative blood loss was lower in the arthroscopy group than that in the traditional group, and the hospitalization time and fracture healing time were shorter (P < 0.05); the levels of serum IgG, IgM and IgA decreased in the two groups on the 1st and 3rd day after operation, but the arthroscopy group was higher than the traditional group (P < 0.05); The levels of serum TRAP-5b in the two groups after 2 weeks and 1 month after operation were lower than those before the operation, and the arthroscopy group was lower than the traditional group, serum BAP and OCN levels were higher than before surgery, and the arthroscopy group was higher than the traditional group (P < 0.05); After 6 months of follow-up, no cases were lost to follow-up, and the KSS scores of the two groups at 3 and 6 months after operation were higher than those before the operation, and the arthroscopy group was higher than the traditional group, the VAS score was lower than before surgery, and the arthroscopy group was lower than the traditional group (P < 0.05). The excellent and good rate of range of motion of the knee joint in the arthroscopy group was 90.32% higher than that in the traditional group was 70.00% (P < 0.05).Conclusion The treatment of patella fractures with minimally invasive Kirschner wire tension band internal fixation assisted by arthroscopy can effectively reduce intraoperative blood loss, reduce the damage of humoral immune function, shorten the length of hospital stay, promote fracture healing, reduce the degree of pain, and improve knee function and range of motion.