自制骨科导向复位钳在髌骨骨折术中应用  

Preliminary clinical application of newly developed guiding reduction forceps for transverse patellar fractures

作　　者：段强民[1,2] 房清敏[3] 王志刚[4] 

机构地区：[1]滨州医学院,烟台264000 [2]滨州医学院附属淄博市临淄区人民医院骨一科,淄博255400 [3]滨州医学院附属医院脊柱外科,滨州256603 [4]滨州医学院附属医院创伤骨科,滨州256603

出　　处：《中国矫形外科杂志》2017年第6期549-553,共5页Orthopedic Journal of China

摘　　要：[目的]探讨自行研制骨科导向复位钳在髌骨骨折术中的临床应用效果。[方法]2012年2月~2015年12月,对70例符合纳入标准的横行髌骨骨折进行临床研究,按照入院顺序随机分为导向复位钳组35例和点式复位钳组35例。两组均采用胥氏改良张力带钢丝固定法固定。导向复位钳组采用导向复位钳加压复位减少骨折间隙、引导克氏针置入。点式复位钳组采用点式复位钳复位,不借助任何定位导向置入克氏针。观察手术时间、克氏针首次置入位置、置入次数、透视次数、遗留的骨折端间隙,并依B?stman评分标准对膝关节功能进行评估。[结果]随访12个月~2年。骨折均愈合,愈合率100%。导向复位钳组在手术时间、穿针次数、置针准确性方面均优于点式复位钳组,差异有统计学意义(P<0.05)。[结论]骨科导向复位钳在髌骨骨折手术中有利于克氏针的准确置入,降低了手术难度,可减少术中X射线暴露,临床疗效良好。[Objective] To explore the outcome of the guiding reduction forceps newly developed by us in the treatment of patellar fracture. [Method] Between February 2012 and December 2015, 70 patients with displaced transverse fractures of the patella who met the inclusion criteria were randomly divided into the guiding reduction forceps group （the Group A, 35 patients） and the point reduction forceps group （the Group B, 35 patients） according to the order of admission. All patients underwent internal fixation with Xu＇s modified anterior tension band wiring fixation, which is two-separate-tension-band technique.ln the Group A, the guiding reduction forceps developed by us were used to reduce the fracture gap by compressing, then temporarily fix the patellar, and guide the K-wires placement for fixation, whereas in the Group B the fracture was reduced and temporarily fixed using point reduction forceps without any positioning guidance. The operative time, the K- wires＇ initial implant position, the number of drillings, the number of X-ray exposures, as well as the residual fracture gap were compared between the two groups. Clinical outcome was evaluated using the Brstman scoring system. [Results] The follow-up time ranged from 12 to 24 months. M1 fractures healed, with a union rate of 100%. The operating time was significantly shorter in the Group A than that in the Group B （P 〈 0.05） . In addition, the former was significantly superior to the latter in the operation time elapsed, the number of drillings, the number of X-ray exposures and the accuracy of K-wires placement as well （P 〈 0.05） . [Conclusion] The guiding reduction forceps do improve the accuracy and quality of insertion of intension-band wiring for patellar fractures, therefore, it can reduce the operation difficulty and the X-ray exposure, and are able to deliver good clinical outcomes.

关 键 词：髌骨骨折 张力带 骨科导向复位钳 

分 类 号：R687.3[医药卫生—骨科学]