髌骨下极撕脱粉碎性骨折合并髌韧带损伤的治疗  

MANAGEMENT OF INFERIOR POLAR COMMINUTED FRACTURES OF PATELLA AND PATELLAR TENDON INJURY

作　　者：章云童[1] 王攀峰[1] 张春才[1] 付青格[1] 张欣[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《中国修复重建外科杂志》2011年第8期976-979,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨髌骨下极撕脱粉碎性骨折合并髌韧带损伤的治疗方法与临床效果。方法 2003年1月-2008年12月,采用镍钛记忆合金聚髌器内固定及阔筋膜移植修复5例交通事故伤致髌骨下极撕脱粉碎性骨折合并髌韧带损伤。其中男3例,女2例;年龄20～48岁,平均33.7岁。骨折程度:3例髌骨下极3个骨折块,2例4个骨折块;髌韧带损伤情况:3例韧带中段横型撕裂,1例近胫骨结节处斜型撕裂,1例纵向撕裂尚未完全离断。受伤至手术时间为1～5 d。结果患者术后切口均Ⅰ期愈合,无感染、深静脉血栓形成等并发症发生。术后第2天复查X线片示髌骨高度与髌韧带长度比例恢复1∶1。5例均获随访,随访时间10～22个月,平均18个月。术后3～12周4例患侧膝关节屈曲度达健侧水平,1例膝关节屈曲功能稍差(约100°)。术后3～5个月骨折均达骨性愈合。术后12～15个月取出聚髌器,均未发生骨折复位丢失或再骨折。随访期间无骨折块移位、植入物松动和断裂、髌韧带再次断裂等并发症发生。末次随访时根据张春才等膝关节评分标准评定疗效:获优3例,良1例,可1例,优良率80%;根据胥少汀等综合评分法评定膝关节功能:获优2例,良2例,中1例,优良率80%。结论镍钛记忆合金聚髌器内固定联合阔筋膜移植修复髌骨下极撕脱粉碎性骨折合并髌韧带损伤可有效恢复伸膝装置的完整性,内固定充分可靠,局部应力诱导成骨,结合术后早期功能锻炼能获得满意疗效。Objective To investigate the treatment and effectiveness of inferior polar comminuted tractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years （range, 20-48 years）. The interval of injury and operation was 1-5 days. Fracture degree： 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree： 3 cases had horizontal rupture of middle ligament, 1 case had oblique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Healing of incision by first intention was achieved in all patients, and no complication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 ： 1. Five cases were followed up 18 months on average （range, 10-22 months）. At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture healing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai＇s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting＇s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat infer

关 键 词：髌骨下极粉碎性骨折 髌韧带损伤 内固定 修复重建 

分 类 号：R687.3[医药卫生—骨科学]