普迪思线张力带固定治疗髌骨骨折的临床研究  

Clinical study of polydloxanone suture tension band fixation for treatment of patellar fractures

作　　者：刘远禄[1] 李帮春[1] 苟景跃[1] 高劲谋[2] 王珏[1] 廖强[3] 晏伟[1] 田开熙[1] 胡建华[1] 

机构地区：[1]重庆市急救医疗中心骨科,400014 [2]重庆市急救医疗中心创伤科,400014 [3]重庆大学动力工程学院

出　　处：《中华创伤杂志》2005年第4期279-282,共4页Chinese Journal of Trauma

基　　金：重庆市卫生局医学科技资助项目(01-2-003)

摘　　要：目的　探讨普迪思(polydloxanonesuture, PDS)可吸收线固定的生物力学性能及其治疗髌骨骨折的效果。　方法　以WDW305型电子万能试验机施行PDS0 -0线和PDS1 -0线的拉力试验。本组患者60例,随机选择30例髌骨骨折为PDS可吸收线张力带治疗组,另30例为克氏针钢丝张力带对照组。直视下解剖复位,巾钳固定。治疗组用直径1. 5mm的克氏针,在骨折远近端或与折线垂直的两侧各横行侧位髌骨前后径中心或稍偏后钻两孔,分别穿入两道PDS0-0线或PDS1-0线,近端的内侧头线和远端的外侧头线、近端的外侧头线和远端的内侧头线分别在髌骨骨折前缘作交叉张力带打结固定,另在近端的内侧头线和远端的内侧头线、近端的外侧头线和远端的外侧头线作髌骨骨折内缘、外缘压力带打结固定。对照组用直径2. 0mm的克氏针及1. 0mm的钢丝同法施行“8”字张力带固定。　结果　通过拉力试验, PDS0 -0线单股的最大拉力为71. 50N, PDS1-0线单股的最大拉力为97. 48N,测试中达到最大拉力时,其长度为原长度的3倍。两组患者全部获得随访,骨折平均愈合时间为2个月,未发生骨折断端再移位。PDS线治疗组,优21例,良6例,可3例;克氏针钢丝张力带对照组;优19例,良7例,可4例。两组临床效果比较,差异无统计学意义(χ2 =0. 32, P>0. 05)。Objective To explore biomechanic characteristics and clinical outcome of absorbable polydloxanone (PDS) treating patellar fractures. Methods The tensile strength test of PDS 0-0 or PDS 1-0 sutures were made in WDW305 electro-universal tester. A total of 60 cases were classified randomly and equally into two groups: treatment group (treated with the absorbable PDS tension band) and Kirschner wirs metals tension band control group (control group). Anatomy reduction was performed with towel clip fixation during operation. Treatment group was managed with diameter 1.5 mm Kirschner wires drilling two pores on the near or distal segment of patellar fracture end and penetrating through two strands of absorbable PDS 0-0 or PDS 1-0 sutures for a satisfactory fracture fixation. Control group was treated with Kirscgner wires (2.0 mm in diameter) and steel wire (1.0 mm in diameter) of type “8” tension band fixation. Results Tensile strength testing showed that the biggest tensile of a strand PDS 0-0 sutures was 71.50 Nand that of PDS 1-0 97.48 N, when the length was three times more than the initial. Two groups were followed up and the mean fracture healing time was two months, without broken wire or dislocation. Treatment group showed excellent clinical results in 21 cases, good in six and fair in three; while control group showed excellent clinical results in 19 cases, good in seven and fair in four, with no statistical difference compared with treatment group (χ2=0.32, P>0.05). Conclusions Absorbable PDS tension band has better characteristics of mechanics and creepage in treating patellar fractures. It can avoid defects of secondary operation and complications like needle-tail pain and sharpen skin resulted from metal tension band fixation. Meanwhile, it is economic and worthy of further clinical application.

关 键 词：髌骨骨折 临床研究 固定治疗 克氏针钢丝张力带 可吸收线张力带 生物力学性能 电子万能试验机 钢丝张力带固定 平均愈合时间 临床效果比较 PDS 交叉张力带 内侧头 治疗组 对照组 解剖复位 骨折断端 Ⅱ期手术 推广应用 拉力 

分 类 号：R687.3[医药卫生—骨科学]