CAJ | 학술논문

目的探讨经皮微创张力带固定术治疗髌骨横形骨折的临床疗效. 方法回顾性分析2009年5月至2011年6月收治的51例髌骨横形骨折患者资料,根据固定方式不同分为微创组(采用微创张力带固定术)和切开复位组(采用切开复位AO张力带固定术),微创组27例,男19例,女8例；年龄19 ～ 43岁,平均(28.3±3.2)岁.切开复位组24例,男18例,女6例；年龄21 ～44岁,平均(29.1±3.5)岁.比较两组患者的骨折复位时间、骨折愈合时间、屈膝90°疼痛视觉模拟评分(VAS)、大腿周径较健侧下降值、关节活动度较健侧下降值及Lysholm膝关节功能评分等. 结果微创组术后骨折复位优良率(88.9％)高于切开复位组(79.2％),骨折愈合时间[(10.9±1.3)周]短于切开复位组[(12.5±1.5)周],术后1周、1个月屈膝90°疼痛VAS评分、术后1、3、6、12个月大腿周径较健侧下降值均低于切开复位组,术后1、3个月关节活动度较健侧下降值、Lysholm膝关节功能评分明显优于切开复位组,以上项目两组间比较差异均有统计学意义(P＜0.05)；而术后3个月屈膝90°疼痛VAS评分、术后6、12个月Lysholm膝关节功能评分两组比较差异均无统计学意义(P＞0.05). 结论微创张力带固定术具有手术创伤小、在关节镜辅助下骨折复位更加准确、骨折愈合时间短等优点,有利于患者早期进行功能锻炼,适用于断端分离＜3 cm的髌骨横形骨折.
목적 탐토경피미창장력대고정술치료빈골횡형골절적림상료효. 방법 회고성분석2009년5월지2011년6월수치적51례빈골횡형골절환자자료,근거고정방식불동분위미창조(채용미창장력대고정술)화절개복위조(채용절개복위AO장력대고정술),미창조27례,남19례,녀8례；년령19 ～ 43세,평균(28.3±3.2)세.절개복위조24례,남18례,녀6례；년령21 ～44세,평균(29.1±3.5)세.비교량조환자적골절복위시간、골절유합시간、굴슬90°동통시각모의평분(VAS)、대퇴주경교건측하강치、관절활동도교건측하강치급Lysholm슬관절공능평분등. 결과 미창조술후골절복위우량솔(88.9％)고우절개복위조(79.2％),골절유합시간[(10.9±1.3)주]단우절개복위조[(12.5±1.5)주],술후1주、1개월굴슬90°동통VAS평분、술후1、3、6、12개월대퇴주경교건측하강치균저우절개복위조,술후1、3개월관절활동도교건측하강치、Lysholm슬관절공능평분명현우우절개복위조,이상항목량조간비교차이균유통계학의의(P＜0.05)；이술후3개월굴슬90°동통VAS평분、술후6、12개월Lysholm슬관절공능평분량조비교차이균무통계학의의(P＞0.05). 결론 미창장력대고정술구유수술창상소、재관절경보조하골절복위경가준학、골절유합시간단등우점,유리우환자조기진행공능단련,괄용우단단분리＜3 cm적빈골횡형골절.
Objective To evaluate the clinical value of figure-of-eight wiring in the arthroscopically-assisted internal fixation of transverse patellar fractures.Methods The clinical data were reviewed of 51 patients with transverse patellar fractures who had been treated in our department from May 2009 through June 2011.They were divided into group A using figure-of-eight wiring (percutaneous tension band) (PTB) and group B using open reduction and internal fixation with AO wire tension band (ORIF).In group A,there were 27 patients,19 men and 8 women,aged from 19 to43 years (average,28.3 ±3.2 years).In group B,there were 24 patients,18 men and 6 women,aged from 21 to 44 years (average,29.1 ±3.5 years).The 2 groups were compared in terms of fracture reduction,time for fracture union,visual analogue scale (VAS) of the knee at flexion of 90°,reduced circumference of the affected leg compared with the health leg,reduced range of motion (ROM) compared with the health leg,and Lysholm scores of knee functional recovery.Results There were significant differences between group A and group B in terms of fracture reduction (88.9％ vs.79.2％),time for union (10.9 ± 1.3 weeks vs.12.5 ± 1.5 weeks),VAS scores at one week and one month postoperation,reduced leg circumferences at 1,3,6,12 months postoperation,reduced ROM of the knee at 1 and 3 months postoperation,and Lysholm scores of the knee function at 1 and 3 months postoperation (P ＜ 0.05).There were no significant differences between group A and group B in terms of VAS scores at 3 months postoperation and Lysholm scores of the knee function at 6 months postoperation (P ＞ 0.05).Conclusion Compared with open reduction and internal fixation,minimally invasive surgery with a percutaneous tension band may have advantages of small scar,better fracture reduction with the help of arthroscopy,faster union of fracture and earlier recovery of knee function in the treatment of transverse patellar fractures with displacement less than 3 cm.