髌骨骨折克氏针张力带钢丝内固定术后克氏针松动的原因分析及应对策略  

K- wire loosening after internal fixation with tension band made of K-wire and steel-wire for treatment of patella fractures:cause analysis and coping strategies

作　　者：陈星宇[1] 刘显东[1] 曹万军[1] 杜亮 唐承杰[1] 郑金文[1] CHEN Xingyu LIU Xiandong CAO Wanjun DU Liang TANG Chengjie ZHENG Jinwen(Sichuan Orthopaedic Hospital, Chengdu 610041, Sichuan, China The People~ Hospital of Guang~n district in Guang~n City, Guang＇ an 638550, Sichuan, China)

机构地区：[1]四川省骨科医院,四川成都610041 [2]四川省广安市广安区人民医院,四川广安638550

出　　处：《中医正骨》2017年第1期23-26,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:分析髌骨骨折克氏针张力带钢丝内固定术后导致克氏针松动的可能原因,并探讨其应对策略。方法:收集2014年1月至2015年12月采用克氏针张力带钢丝内固定术治疗后出现克氏针松动的17例髌骨骨折患者的X线片,应用infiniti系统软件测量克氏针退针距离、针尾部的弯曲度数、针尖至髌骨下极的距离以及克氏针与股四头肌轴线的夹角,并采用Pearson相关分析法分析退针距离与其他3项参数的关系。结果:克氏针退针距离[(10.02±5.56)mm]与克氏针尾部的弯曲度数(117.30°±3.52°)、克氏针和股四头肌轴线的夹角(17.35°±1.75°)均呈负相关(r=-0.774,P=0.013;r=-0.710,P=0.007),与克氏针针尖至髌骨下极的距离[(11.17±0.81)mm]呈正相关(r=0.550,P=0.037)。结论:导致髌骨骨折克氏针张力带钢丝内固定术后克氏针松动的可能原因包括克氏针尾部弯曲度数小、克氏针和股四头肌轴线的夹角小、克氏针针尖至髌骨下极的距离大。术中应适当增加克氏针尾部的弯曲度数及克氏针与股四头肌轴线的夹角,适当控制克氏针针尖至髌骨的距离,以降低克氏针松动的可能性。Objective： To study the possible causes and coping strategies of K- wire loosening after internal fixation with tension band made of K- wire and steel- wire for treatment of patella fractures. Methods： The X- ray films of 17 patients with patella fractures who developed K- wire loosening after internal fixation with tension band made of K- wire and steel- wire from January 2014 to December 2015 were collected. The needle withdrawal distance,bending- degree of needle tail,distance from needle tip to patellar distal extreme and included angle between K- wire and axis of quadriceps femoris were measured by using infiniti system software,and the relationships between needle withdrawal distance and other 3 parameters were analyzed by using Pearson correlation analysis. Results： The needle withdrawal distance（ 10. 02 ＋ /- 5. 56 mm） was negatively correlated（ r =- 0. 774,P = 0. 013; r =- 0. 710,P = 0. 007） with the bending- degree of needle tail（ 117. 30 ＋ /- 3. 52 degrees） and the included angle between K- wire and axis of quadriceps femoris（ 17. 35 ＋ /- 1. 75 degrees）,and was positively correlated（ r = 0. 550,P = 0. 037） with the distance from needle tip to patellar distal extreme（ 11. 17 ＋ /- 0. 81 mm）.Conclusion： The possible causes of K- wire loosening after internal fixation with tension band made of K- wire and steel- wire for treatment of patella fractures include small bending- degree of needle tail,small included angle between K- wire and axis of quadriceps femoris and long distance from needle tip to patellar distal extreme,so the bending- degree of needle tail and the included angle between K- wire and axis of quadriceps femoris should be properly increased and the distance from needle tip to patellar distal extreme should be properly controlled in the surgery so as to reduce the possibility of K- wire loosening.

关 键 词：髌骨 骨折 骨折固定术 内 手术后并发症 相关分析 克氏针松动 

分 类 号：R274.1[医药卫生—中医骨伤科学]