空心钉钛缆内固定治疗髌骨骨折  

Treatment of pateHar fractures with cannulated screws and a titanium cable

作　　者：王树青[1] 张鹏[1] 王家骐[1] 饶志涛[1] 闵晓晖[1] 

机构地区：[1]同济大学附属上海同济医院骨科,上海200065

出　　处：《中华创伤骨科杂志》2011年第7期653-656,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨空心钉钛缆内固定治疗髌骨骨折的疗效。方法2008年2月至2010年9月共收治27例髌骨骨折患者，男11例，女16例；年龄23～65岁，平均44．2岁。均为闭合性髌骨骨折。骨折按Rockwood分型：Ⅱ型11例，Ⅲ型9例，Ⅳ型5例，V型2例。采用直切口复位骨折后略屈膝关节，用2枚1．25mm导针经髌骨上极或下极平行钻入，钻孔后沿导针拧入4．0mm半螺纹自攻空心螺钉，经空心钉穿入1．3mm钛缆锁紧形成“8”字张力带结构。术后早期开始功能锻炼。结果27例患者术后获平均12个月（6～24个月）随访。随访6周时所有患者骨折均达到临床愈合标准，于平均2．6个月（2—3个月）获骨性愈合。膝关节屈曲0～130。。随访期间无钛缆松动、断裂、骨折分离、感染及排斥反应等并发症发生。按照Bostman髌骨骨折功能评定标准评定疗效：优24例，良3例，优良率为100％。结论空心钉钛缆内固定具有操作简便、固定牢靠、可以早期活动关节及疗效确切等优点，是一种治疗髌骨骨折的较好方法。Objective To evaluate clinical effects of cannulated screws and a titanium cable in the treatment of patellar fractures. Methods From February 2008 to September 2010, 27 patients with patellar fracture were treated in our department. They were 11 males and 16 females, with an average age of 44. 2 years （from 23 to 65 years） . All cases were closed fracture without other injuries. According to the Rockwood＇ s classification, 11 cases were Type II, 9 Type II, 5 Type IV and 2 Type V. After open reduction, 2 guide pins （ 1.25 mm） were drilled vertically through the patella in a superior or inferior direction to let half-threaded tapping cannulated screws go 4. 0 mm along the guide pin. A 1.3 mm titanium cable traversed the cannulated screws and formed an 8-shaped tension band structure. All patients conducted knee joint isometric contraction one to 2 days after operation, did continuous passive motion （CPM） exercise after 3 days, walked with the brace after one week, did active flexion and extension training after 2 weeks, removed the brace protection after 3 weeks and conducted weight-bearing walking after 6 weeks. Results The 27 patients were followed up for an average of 12 months （from 6 to 24 months） . All patients achieved clinical healing after 6 weeks and bony consolidation after an average of 2. 6 months （2 to 3 months）. The mean range of motion of the keen was 0 to 130°. Fractures healed without such complications as loosening of cable loop, screw breakage, soft tissue infection or rejection reaction. By the Bostman＇s criteria, functional recovery was excellent in 24 cases and good in 3, with an excellent to good rate of 100%. Conclusion Treatment of patellar fractures with cannulated screws and a titanium cable is characterized by simple manipulation, reliable fixation, early rehabilitation and a high healing rate.

关 键 词：髌骨 骨折固定术 内 骨钉 钛 

分 类 号：R687.3[医药卫生—骨科学]