膝关节内骨软骨骨折块内固定方式及其愈合效应  

Internal fixation and healing of ostecchondral fracture block of knee joint

作　　者：康锦[1] 汤守营[1] 张绪斌[1] 王晓军[1] 张全顺[1] 

机构地区：[1]解放军第二五一医院骨关节科,河北省张家口市075000

出　　处：《中国临床康复》2006年第12期24-26,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:探讨不同固定方法对膝关节内骨软骨骨折块愈合及疗效的影响。方法:选择1999-05/2004-10解放军第251医院收治的50例膝关节损伤合并关节内游离骨软骨折块患者,均行开放关节内固定手术,骨软骨骨折块分别采用粗丝线缝合固定、细克氏针固定、钢丝固定、普通螺丝钉固定、Herbert螺钉固定5种固定治疗方式。术后除细克氏针固定者6～8周拆除石膏外固定、拔除克氏针后进行膝关节功能锻炼外,其他固定方式组均早期进行间歇被动和主动活动。术后1,6周、3,6,12个月膝关节正侧位X射线片观察骨折线、关节面平整度、软骨下骨密度;关节镜下或直视下软骨质量、颜色、平整度、关节内粘连度;术后6,12个月用美国特种外科医院膝关节评分(HSS评分)评估膝关节功能恢复情况。结果:50例患者均进入结果分析。①35例采用普通螺丝钉固定、Herbert螺钉固定的患者关节功能恢复良好,无疼痛,HSS膝关节评分均为优,X射线片显示:骨折全部愈合,关节面平整;其中13例患者6～12个月要求取出内固定螺丝钉,开放关节直视下观察了骨软骨折块愈合情况较好,软骨接近正常或相近。②15例采用粗丝线缝合固定、细克氏针固定、钢丝固定患者于术后6～12个月下地后行走不适、轻微疼痛、关节功能恢复略差,HSS膝关节评分为良,X射线片显示:骨折全部愈合,关节面平整度略差,可见骨折局部轻微增生硬化表现;进行关节镜检查或开放关节取内固定材料,间接或直接观察了骨软骨骨折愈合情况较差,软骨为纤维瘢痕组织替代,与纤维软骨组织接近,尤以克氏针固定方法软骨愈合质量最差。结论:普通螺丝钉固定和Herbert螺钉固定均能达到较好的复位和加压效果,有利于软骨的愈合和修复。提示膝关节骨软骨骨折块的自然愈合质量与其复位、牢固加压固定,早期进行关节功能锻炼有关。AIM： To explore the influence of different fixed ways on healing and curative effect of osteochondral fracture block of knee joint. METHODS： A total of 50 patients with knee joint injury combing free cartilage block of joint from the 251 Hospital of Chinese PLA between May 1999 and October 2004 were selected. They were all treated with opening internal fixed operation in joint. The osteochondral fracture blocks were fixed with thick silk suture, thin Kirschner wire, steel wire, common screw or Herbert lag bolt. After operation, the external fixation was done in the patients fixed with thin Kirschner wire at the 6^th-8^th weeks. Exercise of knee joint function was performed after pulling out Kirschner wire. Passive and initiative activity was conducted intermittently in the other groups in an early period. Fracture line, flat degree of articular surface and density of lower bone of cartilage were observed with X-ray at positive lateral of knee joint at the 1^st, 6^th weeks, 3^rd, 6^th and 12^th months after operation. Mass, color, flat degree and adherence of cartilage were observed under arthroscope or looking steadily. Recovery of knee joint function was assessed with knee joint evaluation of Hospital for Special Surgery of America （HSS assess- ment） at the 6^th and 12^th months. RESULTS： Totally 50 patients were involved in the result analysis. ① Functional recovery of joint was good, without pain, in thirty-five patients who were fixed with common screw or Herbert lag belt. Score of HSS knee joint was excellent. The X-ray revealed that the fracture was healing fully, and the articular surface was flat, Thirteen patients required getting the internal screw out at 6-12 months. Healing status of cartilage fracture block was good when looking steadily in opening joint, and the cartilage was near to normal or similar. ②The 15 patients fixed with thick silk suture, thin Kirschne＇r wire or steel wire after operation for 6-12 months felt slight ache when walking, and the recovery of joint function was

关 键 词：膝关节/外科学 骨折固定术 内 骨折愈合 

分 类 号：R274.1[医药卫生—中医骨伤科学]