髌韧带减张与髌骨下极切除治疗髌骨下极粉碎性骨折疗效比较  

Comparison between patella ligament wiring and inferior polar patellectomy for inferior polar fracture of the patella

作　　者：王显林[1] 冉学军[1] 邓长青[1] 苏琴[1] 胡兆洋[1] 蒲川成[1] 周勇[1] 

机构地区：[1]广安市人民医院(川北医学院附属广安医院)骨二科,四川广安638001

出　　处：《临床骨科杂志》2010年第3期295-297,共3页Journal of Clinical Orthopaedics

摘　　要：目的比较采用髌韧带减张与髌骨下极切除治疗髌骨下极粉碎性骨折的临床疗效。方法 33例(A组)髌骨下极粉碎性骨折采用髌骨下极切除重建伸膝装置治疗,27例(B组)采用髌韧带减张恢复髌骨正常解剖治疗。两组均采用膝前纵切口显露髌骨,A组去除髌骨下极碎骨块,修复伸膝装置;B组先在髌骨近断段端骨块和胫骨结节上用φ1.5mm克氏针横向平行钻一骨隧道,然后屈膝45°用φ1.25mm钢丝行"8"字减张固定,伸直位复位髌骨骨折,修补髌前腱膜和股四头肌扩张部来固定髌骨骨折。两组术后均用石膏托固定3～6周。结果 A组33例中29例获得随访,时间12～21个月,骨折全部愈合;B组27例中24例获得随访,时间12～24个月,骨折全部愈合。两组间愈合率和愈合时间差异无统计学意义(P>0.05)。HSS膝关节评分两组差异有统计学意义(P<0.05)。两组最大膝关节屈曲度差异有统计学意义(P<0.05),最大膝关节过伸度差异无统计学意义(P>0.05)。结论采用髌骨下极切除治疗髌骨下极粉碎性骨折常导致髌骨整体下移而出现"错格现象",且合并髌股关节压力增加而导致膝关节疼痛,易过早发生髌股关节创伤性关节炎;部分患者在屈膝活动中出现髌骨倾斜,在伸膝时出现力量减弱。采用髌韧带减张重建髌骨正常解剖治疗髌骨下极粉碎性骨折则克服了上述不足,膝关节功能恢复明显优于前者。Objective To compare the effect between patella ligament wiring and inferior polar patellectomy for inferior polar fracture of the patella.Methods 33 cases of inferior polar fracture of the patella（group A）were undergone excision of inferior polar of the patella and 27 cases（group B）by repairing patella ligament with wring were recruited.The anterior longitudinal incision of the knee was used for all patients.Group A were performed patellar ligament origin reconstruction.Group B were undergone drilling a transversal bone tunnel at tubercle of tibia and near fracture end of the patella,then fixing tubercle of tibia and near fracture end of the patella by using a diameter  1.25 mm steel-wire of ＂8＂ at 45° of genu flex and positioning patellar fracture.The front aponeurosis of patella and quadriceps femoris pavilion were repaired for fixing patellar fracture.Plaster splint was used for all patients postoperation about 3～6 weeks.Results 29 patients of group A were followed up for 12~21 months,the tendon and bone got healing;27 patients of group B were followed up for 12~24 months,and the fractures all healed.There is no statistical significance between heal rate and heal time（P0.05）.HSS scale of the knee function and the maximum range of flexion were with statistical significance（P0.05）.The maximum range of hyperextension was not statistical significant different（P0.05）.Conclusions Inferior polar patellectomy increases patellofemoral joint pressure and leads to arthralgia and traumatic arthritis;The patella declines during flexion,and the extensor mechanism is destroyed.Reconstructing normal anatomy of the patella through patella ligament wring overcomes the above-mentioned shortages and surpasses the former for functional rehabilitation of the knee.

关 键 词：髌骨骨折 髌韧带 髌骨/外科学 

分 类 号：R683.42[医药卫生—骨科学] R687.4[医药卫生—外科学]