改良张力带内固定与镍钛聚髌器内固定治疗髌骨横形骨折的比较研究  

A comparative study of modified tension-band internal fixation versus nickel-titanium patellar concentrator internal fixation for treatment of patellar transverse fractures

作　　者：申晟 代朋乙 袁延浩 谭红略 SHEN Sheng;DAI Pengyi;YUAN Yanhao;TAN Honglue(Luoyang Orthopedic - Traumatological Hospital,Zhengzhou 450016,Henan,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南郑州450016

出　　处：《中医正骨》2018年第4期28-31,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省科技攻关计划项目(172102310455)

摘　　要：目的:比较改良张力带内固定与镍钛聚髌器内固定治疗髌骨横形骨折的临床疗效和安全性。方法:回顾性分析2010年6月至2014年10月接受手术治疗的63例髌骨横形骨折患者的病例资料,接受改良张力带内固定手术治疗者34例(改良张力带组),接受镍钛聚髌器内固定手术治疗者29例(镍钛聚髌器组)。比较2组患者的手术时间、骨折愈合时间、并发症发生情况及末次随访时的B9stman髌骨骨折临床疗效评分。结果:2组患者均顺利完成手术。手术时间改良张力带组(60.35±7.05)min、镍钛聚髌器组(61.83±6.23)min,2组患者手术时间的组间差异无统计学意义(t=-0.880,P=0.384)。2组患者均获随访,随访时间24~36个月,中位数26个月。骨折均愈合,骨折愈合时间改良张力带组(13.96±0.45)周、镍钛聚髌器组(14.23±0.51)周,2组患者骨折愈合时间的组间差异无统计学意义(t=-0.380,P=0.674)。末次随访时的2组患者膝关节B9stman评分比较,差异无统计学意义[(29.35±1.55)分,(29.59±1.05)分,t=0.712,P=0.496]。改良张力带组,术后并发膝关节活动时疼痛12例,骨折愈合后取出内固定,疼痛缓解;并发克氏针或张力带钢丝(钛缆)移位、松动4例,行支具外固定至骨折愈合。镍钛聚髌器组无膝关节疼痛及内固定移位、松动等并发症发生。改良张力带组术后并发症发生率高于镍钛聚髌器组(P=0.000)。结论:镍钛聚髌器内固定与改良张力带内固定治疗髌骨横形骨折的临床疗效相当,但前者固定更牢固,安全性更高。Objective： To compare the clinical curative effects and the safety of modified tension - band internal fixation versus nickel - titanium patellar concentrator internal fixation in the treatment of patellar transverse fractures. Methods： The medical records of 63 patients with patellar transverse fractures who received surgical treatment from June 2010 to October 2014 were analyzed retrospectively. Thirty - four patients were treated with modified tension - band internal fixation（ group A） , while the others were treated with nickel - tita-nium patellar concentrator internal fixation （ group B） . Operative time, fracture healing time, complication incidence and Bostman clinical ef-ficacy scores of patellar fracture at last follow - up were compared between the 2 groups. Results： The surgeries were finished successfully in all patients,and there was no statistical difference in the operative time between group A and group B（60. 35 ＋/-7. 05 vs 61.83 ＋/-6. 23 min,^ = -0. 880,P =0. 384）. The patients in the 2 groups were all followed up for 24 -36 months with a median of 26 months. All frac-tures healed in the 2 groups,and there was no statistical difference in the fracture healing time between the 2 group（ 13. 96 ＋/-0. 45 vs 14.23 ＋/-0.51 weeks,-0. 380,P =0 .6 7 4 ） . There was no statistical difference in the Bostman knee scores between the 2 group at last follow - up（29. 35 ＋/- 1.55 vs 29. 59 ＋/- 1.05 points,t =0. 712,P =0. 496） . Knee pain during daily activities were found after the sur-gery in 12 patients in group A and were relieved after the fractures healed and the internal fixators were removed. Displacement and loose-ning of kirschner wires or tension - band wires（titanium cable）were found in 4 patients in group A,and the external fixation with orthoses were performed on the 4 patients until the fracture healed completely. No complications such as knee pain and displacement and loosening of internal fixators were found in group B. The postop

关 键 词：骨折 髌骨 骨折固定术 内 张力带 镍钛聚髌器 

分 类 号：R687.3[医药卫生—骨科学]