The purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures. Between January 1987 and December 2003, this retrospective study included a total of 35 patients (mean age, 51.4±16.8 years) with a minimum of 10 years follow-up period, comprising 29 males and 6 females, who were divided into the total patellectomy group (17 patients) or the open reduction and internal fixation (ORIF) group (18 patients) in the Third Affiliated Hospital of Hebei Medical University. We retrospectively collected patient demographics and data on the type of trauma, fracture type, and postoperative complications. Clinical outcomes including knee range of motion (ROM), 36-Item Short-Form Health Survey (SF-36) score [including physical component score (PCS) and mental component score (MCS)], Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were evaluated and compared between the two groups. Biodex System dynamometer was used to quantitatively evaluate quadriceps femoris muscle power following measurement of peak torque. The mean follow-up periods of the total patellectomy group and the ORIF group were 17.2±5.6 and 16.8±4.9 years, respectively. There were no significant differences between the two groups of patient demographics in terms of the number of patients, age, sex, injury side, time to surgery, type of trauma, and fracture classification (p>0.05). Total patellectomy was comparable to osteosynthesis with tension band wiring in terms of ROM [injured knee: 120.4±3.1° vs 118.6±3.3°; uninjured knee: 126.5±2.8° vs 127.3±1.7°; both p>0.05], peak torque [Injured knee: 96.2±2.3 vs 97.3±2.6, N· m; Uninjured knee: 107.6±2.1 vs 106.3±1.8, N· m; both p>0.05], SF-36 score [PCS: 64.1±18.0 vs 61.5±17.9; MCS: 55.1±13.8 vs 54.3±12.4; both p>0.05], KOOS score [76.3±12.1 vs 73.4±11.7; p>0.05], and Kujala score [67.6±11.8 vs 70.8±11.9; p>0.05] at the final follow-up, while total patellectomy had significantly shorter operation time than ORIF group (47.5±12.1 vs 68.8±22.3, min, p<0.05). In the total patellectomy group, complications occurred in 6 of 17 cases (35.3%), and all occurred with calcification. In the ORIF group, complications occurred in 12 of 18 cases (66.7%), including 2 cases of infection (11.1%), 1 case of non-union (5.6%), 2 cases of implant failure (11.1%), 2 cases of soft tissue irritation (11.1%), and 5 cases of patellofemoral arthritis (27.8%). Total patellectomy technique was a safe and reliable alternative treatment for treating patients with highly comminuted patella fractures when anatomically reduction and rigid fixation were difficult, although it caused relatively higher rates of calcification.

中文翻译：

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高度粉碎性髌骨骨折患者的全髌骨切除术和接骨术与张力带布线的比较：一项 10-20 年的随访研究

本研究的目的是评估和比较高度粉碎性髌骨骨折患者的全髌骨切除术和张力带固定接骨术之间的长期临床结果。1987 年 1 月至 2003 年 12 月，本回顾性研究共纳入 35 例患者（平均年龄 51.4±16.8 岁），随访时间最短 10 年，其中男性 29 例，女性 6 例，分为全髌骨切除术。河北医科大学第三附属医院切开复位内固定（ORIF）组（17例）或切开复位内固定（ORIF）组（18例）。我们回顾性收集了患者的人口统计资料和有关创伤类型、骨折类型和术后并发症的数据。临床结果，包括膝关节活动度 (ROM)，对 36 项简短健康调查 (SF-36) 评分 [包括身体成分评分 (PCS) 和心理成分评分 (MCS)]、膝关节损伤和骨关节炎结果评分 (KOOS) 以及 Kujala 评分进行了评估和比较两组。Biodex 系统测力计用于在测量峰值扭矩后定量评估股四头肌肌肉力量。全髌骨切除组和ORIF组的平均随访时间分别为17.2±5.6和16.8±4.9年。两组患者人口统计学在患者数量、年龄、性别、损伤侧、手术时间、外伤类型、骨折分类等方面差异均无统计学意义（p>0.05）。在 ROM 方面，全髌骨切除术与使用张力带布线的接骨术相当[受伤的膝盖：120.4±3.1° vs 118.6±3.3°；未受伤的膝关节：126.5±2.8° vs 127.3±1.7°；p>0.05]，峰值扭矩[受伤膝盖：96.2±2.3 vs 97.3±2.6，N·m；未受伤膝关节：107.6±2.1 vs 106.3±1.8，N·m；p>0.05], SF-36 评分 [PCS: 64.1±18.0 vs 61.5±17.9; MCS：55.1±13.8 对 54.3±12.4；p>0.05], KOOS 评分 [76.3±12.1 vs 73.4±11.7; p>0.05]，Kujala 评分 [67.6±11.8 vs 70.8±11.9；p>0.05]，而全髌骨切除术的手术时间明显短于ORIF组（47.5±12.1 vs 68.8±22.3，min，p<0.05）。髌骨全切组17例中有6例（35.3%）出现并发症，均伴有钙化。ORIF组18例中有12例（66.7%）出现并发症，其中感染2例（11.1%）、不愈合1例（5.6%）、种植体失败2例（11.1%）、2例软组织刺激（11.1%），髌股关节炎5例（27.8%）。在解剖复位和刚性固定困难的情况下，髌骨全切除术是治疗高度粉碎性髌骨骨折患者的一种安全可靠的替代治疗方法，尽管它会导致相对较高的钙化率。