三种内固定方式治疗髌骨骨折的疗效比较  

Comparison of three internal fixation methods for treatment of patellar fractures

作　　者：李明东[1] 黎早敏[1] 陈剑飞[1] 裴国献[2] 马业涛[1] 陈世强[1] 覃俊君[3] 刘键[4] 

机构地区：[1]海南省人民医院创伤骨科,海口570311 [2]第四军医大学附属西京医院骨科,西安710032 [3]广西壮族自治区人民医院骨科,南宁530021 [4]海南省人民医院脊柱骨科,海口570311

出　　处：《中华创伤骨科杂志》2017年第6期532-536,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较髌骨环、克氏针张力带、髌骨环联合克氏针内固定治疗髌骨骨折的临床疗效。方法回顾性分析2009年9月至2016年1月期间收治的285例髌骨骨折患者资料。男155例，女130例，平均年龄为45．5岁（18～70岁）。髌骨骨折分型：横形骨折176例，纵形劈裂骨折28例，粉碎性骨折81例。根据内固定方式不同分3组：髌骨环组98例，采用髌骨环内固定；克氏针张力带组92例，采用克氏针张力带内固定；髌骨环克氏针组95例，采用髌骨环联合克氏针内固定。比较3组患者的手术时间、术中出血量、骨折愈合时间、患膝功能及术后并发症发生情况。患膝功能应用Bostman评分标准评定。结果髌骨环组患者手术时间[（58．9±6．4）min]显著短于克氏针张力带组[（71．8±7．8）min]和髌骨环克氏针组[（74．4±8．0）min]，差异均有统计学意义（P〈0．05）。3组患者的术中出血量和骨折愈合时间比较差异均无统计学意义（P〉0．05）。末次随访克氏针张力带组患者患膝功能优良率为100．0％（92／92），显著高于髌骨环组（90．8％，89／98）和髌骨环克氏针组（91．6％，87／95），差异均有统计学意义（P〈0．017）。髌骨环组、克氏针张力带组、髌骨环克氏针组患者术后并发症发生率分别为2．0％（2／98）、1．1％（1／92）、2．1％（2／95），差异无统计学意义（P〉0．05）。结论克氏针张力带内固定术治疗髌骨骨折疗效确切，具有手术损伤小、术后并发症少、能更好地恢复患者患膝功能且价格低廉等优点。Objective To compare patellar ring, Kirschner wire tension band and patellar ling plus Kirschner wire in fixation for treatment of patella fractures. Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016. They were 155 men and 130 women, with an average age of 45.5 years （from 18 to 70 years） . Their fractures included 176 transverse, 28 longitudinal split and 81 comminutcd ones. They were divided into 3 groups according to their different internal fixation methods： patellar ring fixation （98 cases）, Kirschner wire tension band （92 cases）, patellar ring plus Kirschner wire fixation （95 cases）. The 3 groups were compared in terms of operative time, intraoperative bleeding, fracture healing time, knee function by Bfistman score at the last follow-up and postoperative complications. Results The operative time in the patellar ring group（58.9± 6.4 min） was significantly shorter than in the Kirschner wire group （71.8 ± 7.8 min） and in the patellar ring plus Kirschner wire group （74. 4 ± 8.0 min） （ P 〈 0. 05）. There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding （ P 〉 0. 05）. The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0% （92/92）, signifi- cantly higher than in the patellar ring group （90. 8%, 89/98） and in the patellar ring plus Kirschner wire group （91.6%, 87/95 ） （ P 〈 0. 017）. There was no significant difference in postoperative complication rate between the patellar ring fixation group （2.0%, 2/98）, Kirschner wire tension band fixation group （1.1%, 1/92） and the patellar ring plus Kirschner wire group （2. 1%, 2/95） （ P 〉 0. 05） . Conclusion Internal fixation with Kirsehner wire tension band has definite curative effect on patellar fractures, showing the advantages of less operative invasion, fewer pos

关 键 词：髌骨 骨折 骨折固定术 内 内固定器 病例对照研究 

分 类 号：R687.3[医药卫生—骨科学]