关节镜下微创无头加压螺钉内固定与髌骨针联合张力钢丝固定治疗髌骨骨折的优势  

Advantages of Arthroscopic Minimally Headless Compression Screws and Patellar Needles Combined with Tension Wire Fixation in the Treatment of Patellar Fractures

作　　者：李建强[1] 孙虹斐 武强[2] 靳宇[1] 张勇[2] LI Jian-qiang;SUN Hong-fei;WU Qiang;JIN Y-u;ZHANG Yong(Emergency Department, Tangshan People＇s Hospital, Tangshan 603001, Hebei , China)

机构地区：[1]唐山市人民医院急诊科,河北唐山063001 [2]唐山市人民医院骨科,河北唐山063001

出　　处：《中国现代手术学杂志》2018年第1期37-40,共4页Chinese Journal of Modern Operative Surgery

基　　金：河北省卫生厅科技项目(编号:20181238)

摘　　要：目的探究关节镜下微创无头加压螺钉(headless compression screw,HCS)内固定与髌骨针联合张力钢丝固定术治疗髌骨骨折相比传统手术的疗效。方法回顾性分析2015年3月~2017年3月我院收治的髌骨骨折患者56例,15例采用传统切开复位克氏针张力带钢丝固定术(A组),18例实施关节镜下微创无头加压螺钉内固定术(B组),23例行关节镜下微创髌骨针联合张力钢丝固定术(C组),比较三组患者手术时间、术中出血量、骨折愈合情况、关节恢复情况以及术后并发症。结果A、B、C组手术时间分别为(79.3±8.4)min、(52.2±7.3)min、(61.5±7.8)min,两两比较均有统计学意义(P<0.05);A、B、C组患者术中出血量分别为(61.5±8.7)ml、(34.4±5.8)ml、(35.6±4.9)ml,B、C组患者术中出血量差异无统计学意义(P>0.05),与A组的差异有统计学意义(P<0.05);胥少汀疗效结果显示:B、C组患者膝关节功能优良率、膝关节活动优良率以及骨折复位优良率均高于A组患者,差异有统计学意义(P<0.05),B、C组之间的疗效差异无统计学意义(P>0.05);A组4例(26.7%)患者出现术后并发症,B组和C组在随访期间均未出现术后并发症。结论关节镜下微创术结合HCS用于髌骨横型骨折、自折式髌骨针联合张力带钢丝内固定用于髌骨粉碎性骨折临床疗效确切,与传统手术相比手术时间短,损伤小,膝关节功能恢复快,内固定可靠,术后并发症少,值得推广应用。Objective To explore the advantages of arthroscopic minimally headless compression screws（HCS） and patellar needles combined with tension wire fixation in the treatment of patellar fractures. Methods Retrospective analysis was carried out in 56 inpatients of patellar fractures in our hospital,including 15 cases treated with traditional open reduction and Kirschner wire fixation（group A）,18 cases of arthroscopic headless compression screw fixation（group B）,and 23 cases of endoscopic minimally invasive patellar needle combined with tension wire fixation（group C） from March,2015 to March,2017. Results Operation time of group A,B and C was（79. 3 ± 8. 4） min,（52. 2 ± 7. 3） min and（61. 5 ± 7. 8） min with significant difference（P〈0.05）. Intraoperative blood loss of group A,B and C was（61. 5 ± 8. 7） ml,（34. 4 ± 5. 8） ml and（35. 6 ± 4. 9） ml. And there was a significant difference between group B（/C） and group A（P〈0.05）.Weidauers effect showed that the excellent and good rate of knee joint function,knee joint movement and fracture reduction in group B and C group were higher than that of group A（P〈0.05）. In group A,there was 4 cases（26. 7%） had postoperative complications,which was higher than group B（0） and group C（0） during the follow-up period. Conclusion It has definite clinical effects of arthroscopic minimally invasive HCS surgery for patellar transverse fractures,and patellar needles combined with tension band wire fixation for comminuted ones. Compared with the traditional operation,it is recommended of shorter operation time,less injury,quicker knee joint function recovery,more reliable internal fixation,and less postoperative complications.

关 键 词：关节镜 无头加压螺钉 髌骨针 张力带 髌骨骨折 

分 类 号：R816.8[医药卫生—放射医学]