中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2013年
5期
434-437
,共4页
孙浩%赵东风%岳勇%汤志宏
孫浩%趙東風%嶽勇%湯誌宏
손호%조동풍%악용%탕지굉
髌骨骨折%张力带%内固定%外科手术
髕骨骨摺%張力帶%內固定%外科手術
빈골골절%장력대%내고정%외과수술
patellar fracture%tension band%internal fixation%surgical operation
背景：髌骨下极粉碎性骨折具有骨折块小、修复髌腱起点困难等特点，临床如何处理粉碎性骨折块及重建髌韧带功能是亟待解决的问题。<br> 目的：探讨可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折的方法和临床疗效。<br> 方法：2007年8月至2012年12月收治26例髌骨下极粉碎性骨折患者，男15例，女11例；年龄19~65岁，平均42.5岁。患侧髌骨下极粉碎性骨折严重，均无法用克氏针及拉力螺钉固定，术中切除粉碎性骨折块，两枚可吸收带线锚钉依次垂直于髌骨下极，沿骨横截面中轴三等分点拧入，Kessler法缝合髌腱起点，膝关节屈曲90°位8字钢丝减张带固定。<br> 结果：术后切口均Ⅰ期愈合，无一例发生并发症。26例中24例获得随访，随访时间为6个月~5年，平均15.6个月。末次随访时，患者疼痛视觉模拟评分（VAS）为（1.0±0.3）分，患侧膝关节活动度（ROM）与健侧比较无统计学差异（P＞0.05），患侧Lysholm评分优18例、良4例、可1例、差1例，优良率为91.6%。<br> 结论：可吸收锚钉联合8字减张带是治疗髌骨下极粉碎性骨折的有效方法，具有并发症少、术后恢复快等优点。
揹景：髕骨下極粉碎性骨摺具有骨摺塊小、脩複髕腱起點睏難等特點，臨床如何處理粉碎性骨摺塊及重建髕韌帶功能是亟待解決的問題。<br> 目的：探討可吸收錨釘聯閤8字減張帶治療髕骨下極粉碎性骨摺的方法和臨床療效。<br> 方法：2007年8月至2012年12月收治26例髕骨下極粉碎性骨摺患者，男15例，女11例；年齡19~65歲，平均42.5歲。患側髕骨下極粉碎性骨摺嚴重，均無法用剋氏針及拉力螺釘固定，術中切除粉碎性骨摺塊，兩枚可吸收帶線錨釘依次垂直于髕骨下極，沿骨橫截麵中軸三等分點擰入，Kessler法縫閤髕腱起點，膝關節屈麯90°位8字鋼絲減張帶固定。<br> 結果：術後切口均Ⅰ期愈閤，無一例髮生併髮癥。26例中24例穫得隨訪，隨訪時間為6箇月~5年，平均15.6箇月。末次隨訪時，患者疼痛視覺模擬評分（VAS）為（1.0±0.3）分，患側膝關節活動度（ROM）與健側比較無統計學差異（P＞0.05），患側Lysholm評分優18例、良4例、可1例、差1例，優良率為91.6%。<br> 結論：可吸收錨釘聯閤8字減張帶是治療髕骨下極粉碎性骨摺的有效方法，具有併髮癥少、術後恢複快等優點。
배경：빈골하겁분쇄성골절구유골절괴소、수복빈건기점곤난등특점，림상여하처리분쇄성골절괴급중건빈인대공능시극대해결적문제。<br> 목적：탐토가흡수묘정연합8자감장대치료빈골하겁분쇄성골절적방법화림상료효。<br> 방법：2007년8월지2012년12월수치26례빈골하겁분쇄성골절환자，남15례，녀11례；년령19~65세，평균42.5세。환측빈골하겁분쇄성골절엄중，균무법용극씨침급랍력라정고정，술중절제분쇄성골절괴，량매가흡수대선묘정의차수직우빈골하겁，연골횡절면중축삼등분점녕입，Kessler법봉합빈건기점，슬관절굴곡90°위8자강사감장대고정。<br> 결과：술후절구균Ⅰ기유합，무일례발생병발증。26례중24례획득수방，수방시간위6개월~5년，평균15.6개월。말차수방시，환자동통시각모의평분（VAS）위（1.0±0.3）분，환측슬관절활동도（ROM）여건측비교무통계학차이（P＞0.05），환측Lysholm평분우18례、량4례、가1례、차1례，우량솔위91.6%。<br> 결론：가흡수묘정연합8자감장대시치료빈골하겁분쇄성골절적유효방법，구유병발증소、술후회복쾌등우점。
Background:The comminuted fracture of inferior patellar pole is characterized by its small fracture fragments and its diffi-culty in reconstructing the apex of the patellal tendon. How to deal with the comminuted fracture segments and reconstruct the patellal ligament function are the burning questions in clinic. <br> Objective: To investigate the clinical effects of the absorbable anchors and 8-shaped decreasing tension band combined method in treating the comminuted fracture of inferior patellar pole. <br> Methods: From August 2007 to December 2012, 26 patients (15 males and 11 females) with an average of 42.5 (19-65) years old were diagnosed with comminuted fracture of inferior patellar pole. For these patients, the comminuted fracture of in-ferior patellar pole of the affected side was very serious, thus cannot be fixed by kirschner wire and lag screw. During the oper-ation, the comminuted fracture segments were removed. Perpendicular to the inferior patellar pole, 2 absorbable anchors with stitches were screwed into the 2 points which equally divided the axis into 3 parts in the cross section, and sutured the apex of the patellar tendon with Kessler method. Then the knee-joint was fixed with 8-shaped decreasing tension band at a flex of 90°. Results:All incisions were healed without any complication by first intention. Twenty-four of the 26 patients were followed up, and the mean follow-up period was 15.6 months (6 months-5 years). At the last follow-up, the visual analog scores (VAS) of the patients was 1.0 ± 0.3 points, the range of motion (ROM) of the knee-joint had no statistical significance be-tween the affected and the normal side (P>0.05). According to the Lysholm knee scores, there were 18 excellent cases, 4 good cases, 1 fair case, and 1 poor case, the excellent-good rate was 91.6%. <br> Conclusions:Absorbable anchors combined with 8-shaped decreasing tension band is an effective method to treat the com-minuted fracture of inferior patellar pole. It has the advantage of few complications and fast recovery.
