新型可吸收空心螺钉结合不可吸收缝线张力带固定治疗髌骨骨折:与传统改良张力带的对比  

Novel absorbable cannulated screw combined with non-absorbable suture-tension band versus traditional advanced tension band for treating patellar fractures

作　　者：林奕鹏 岳凯[2] 徐盈舒 李棋[1] 黄锡豪 李箭[1] Lin Yipeng;Yue Kai;Xu Yingshu;Li Qi;Huang Xihao;Li Jian(Department of Sports Medicine,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China;Department of Orthopedics,Chengdu First People’s Hospital of Longquanyi District,Chengdu 610100,Sichuan Province,China)

机构地区：[1]四川大学华西医院运动医学科,四川省成都市610041 [2]成都市龙泉驿区第一人民医院骨科,四川省成都市610100

出　　处：《中国组织工程研究》2019年第22期3506-3511,共6页Chinese Journal of Tissue Engineering Research

基　　金：四川省科技厅项目(2017SZ0017),课题名称:全民健身运动医学与健康互动平台建设的关键技术研究与示范,项目负责人:李箭;四川大学华西医院“135”工程项目(ZY2017301),课题名称:膝关节脱位多发韧带损伤华西分期分型及精准诊治体系建立和应用,项目负责人:李箭~~

摘　　要：背景:对于髌骨横行骨折的治疗,传统改良张力带有需要二次手术的风险,并且也需要较长的康复时间。同时还有报道克氏针或钢丝刺破皮肤、引起疼痛等缺点,因此对于治疗方案的改进空间较大。目的:比较可吸收空心螺钉拉力与不可吸收缝线结合张力带固定与传统改良张力带固定治疗髌骨骨折的方法与临床疗效。方法:回顾性分析髌骨横行骨折患者49例的临床资料,其中采用可吸收空心螺钉与不可吸收缝线结合张力带固定的患者16例(A组),采用传统改良张力带的患者33例(B组)。所有患者对治疗方案均知情同意,且得到医院伦理委员会批准。定量或定性比较:术后恢复正常活动时间、住院费用;术后第1天、3个月、6个月膝关节正侧位X射线片;受伤前、术后6,12个月的膝关节功能评分,包括Lysholm和国际膝关节文献委员会评分。结果与结论:①受伤前、术后6个月及术后12个月,A组、B组组内在Lysholm评分和国际膝关节文献委员会评分上差异均有显著性意义(P<0.001);术后6个月,A组评分显著高于B组(P<0.001);术后12个月2组之间差异无显著性意义(P>0.05);②B组患者恢复日常活动所需时间长于A组(P=0.03);③A组患者平均医疗费用为人民币7 833元(8 000-10 000元),B组2次手术费用总和平均为11 769元(10 000-20 000元),B组显著高于A组(P<0.05);④2组患者术后第1天复查X射线片示骨折端对位、对线良好无明显错位,髌骨关节面光滑平整;A组术后3个月X射线片示骨折线模糊,钉帽模糊可见;术后6个月X射线片示骨折线消失,钉帽不可见。B组术后3个月X射线片示有克氏针及钢丝脱离的发生;⑤提示相对于传统改良张力带,新型可吸收空心螺钉与不可吸收缝线张力带在固定治疗髌骨骨折上能取得更好的疗效,可作为未来一种替代的手术方式。BACKGROUND:For transverse patella fractures,traditional advanced tension band possesses the risk for secondary surgery,which needs long-term rehabilitation.Kirschner wire or steel wire may pierce the skin and cause pain,so the treatment scheme needs to be improved.OBJECTIVE:To compare the clinical efficacy of absorbable cannulated screw combined with non-absorbable suture-tension band and traditional advanced tension band for treating patella fractures.METHODS:Clinical data of 49 patients with transverse patella fractures were analyzed retrospectively,including 16 cases of absorbable cannulated screw combined with non-absorbable suture-tension band(group A)and 33 cases of modified traditional tension band(group B).All patients signed the informed contents,and the study was approved by the ethics committee of the hospital.The time of returning normal activity and hospitalization cost were compared.The anteroposterior and lateral film of the knee joint at postoperative 1 day,3 and 6 months,and the Lysholm and International Knee Documentation Committee scores at baseline,postoperative 6 and 12 months were compared.RESULTS AND CONCLUSION:(1)Both groups showed improved Lysholm and International Knee Documentation Committee scores at baseline,postoperative 6 and 12 months(P<0.001).The scores at postoperative 6 months in the group A were significantly higher than those in the group B(P<0.001).There was no significant difference in the scores at postoperative 12 months between two groups(P>0.05).(2)The time of returning normal activity in the group B was significantly longer than that in the group A(P=0.03).(3)The average hospitalization cost in the group A was￥7 833(￥8 000-10 000),and￥11 769(￥10 000-20 000)in the group B(P<0.05).(4)At postoperative 1 day,the X-ray films showed a good alignment and no obvious dislocation,and articular surface was smooth and flat in both groups.At postoperative 3 months,the group A showed obscure fracture line and the obscure nail cap on the X-rays.Fracture line disappeared and th

关 键 词：髌骨骨折 可吸收空心螺钉 不可吸收缝线 内固定 改良张力带 生物力学 骨折线 

分 类 号：R459.9[医药卫生—治疗学]