线捆绑加髌骨针钢丝内固定在粉碎性髌骨骨折术中的应用研究  

Steel-wire binding and ring pins combined with suture cerclage for the treatment of comminuted patella fracture

作　　者：魏小华 刘雄 叶旭标 Wei Xiaohua;Liu Xiong;Ye Xubiao(Traumatic Orthopaedic,Dongguan Eighth People's Hospital,Dongguan Guangdong,523325,China)

机构地区：[1]东莞市第八人民医院骨科医院创伤骨科,广东东莞523325

出　　处：《生物骨科材料与临床研究》2021年第5期43-46,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的研究髌骨针钢丝内固定联合环形线捆绑在髌骨粉碎性骨折治疗中的临床效果。方法选取2017年3月至2020年3月本院骨科医院收治的粉碎性髌骨骨折且需要手术切开复位内固定患者56例,其中男36例,女20例;年龄24~65岁,平均41.6岁。受伤到手术时间4~9 d,平均5.2 d。所有患者行髌骨骨折切开复位髌骨针钢丝联合线捆绑内固定术。手术方法:骨折复位后,两根直径2.0/2.5 mm髌骨针平行垂直钻入复位髌骨,双股2号爱惜邦聚酯不可吸收缝线于髌骨周围做环形缝合,缝线自髌骨周围贴骨穿入,于髌骨周围环形缝合后自穿入点旁穿出备用。直径1 mm钢丝行髌骨"8"字捆绑固定。固定完毕后收紧捆绑缝线于髌骨侧面行改良Nice结固定。观察术后并发症发生情况、骨折愈合时间及膝关节功能恢复情况。结果56例患者均获得至少1年随访,随访时间12~23个月,平均15.3个月。术后1例患者出现切口红肿感染,后予以切口处拆线及负压吸引3周后愈合。随访病例骨折均临床愈合,最长愈合时间4个月。3个月复诊时膝关节最大活动度为128°~135°,平均131.7°。术后半年患膝B?stman髌骨骨折功能评分为24~30分,平均27.8分;术后1年B?stman髌骨骨折功能评分为26~30分,平均28.3分,功能评价优良率100%。随访期间无患者出现骨折移位及内固定物松脱情况发生。结论应用髌骨针钢丝内固定联合线捆绑在治疗粉碎性髌骨骨折中固定可靠,在提高骨折固定稳定性的同时减少了金属内固定装置的使用,降低内固定物对软组织的刺激,便于患者术后早期行膝关节康复锻炼,是髌骨粉碎性骨折有效的手术方式之一。Objective To investigate the clinical effects of steel-wire binding and ring pins combined with suture cerclage for the treatment of comminuted patella fracture.Methods A total of 56 patients with comminuted fracture of patella(36 males and 20 females aging from 24 to 65 years,with an average age of 41.6 years)admitted to our hospital from March2017 to March 2020 were retrospectively analyzed.The interval from injury to surgery was 4-9 d(mean,5.2 d).For the operation,after fracture reduction,two 2.0/2.5 mm ring pins were inserted perpendicular to the transverse axis of the reduced patella and parallel to each other on its medial 1/3 and lateral 1/3.Roll wire was passed through the ring of the pins,rounded making a figure of 8 wiring,and tightened at the distal portion of the ring pin.ETHBOND EXCEL 2 polyester non-absorbable sutures encircled the whole patella,and tighten to achieve a satisfactory reduction of the fracture.During the follow-up,complications were observed,maximum motion range of the knee joint was measured,X-ray examination was performed and fracture healing time was recorded.The knee function was evaluated according to B?stman scores.Results All the 56 patients were followed up 12-23 months(mean,15.3 months).Incision infection occurred in 1 case,no bone nonunion,loss of reduction or displacement of internal fixation occurred.All fractures were clinically healed,and the bone healing time was 2-4 months.Three months after surgery,the maximum motion range of knee joint was 128°-135°,with an average of 131.7°.After 6 months,the B?stman score of the affected knee was24-30(mean,27.8).And the B?stman score of the affected knee was 26-30(mean,28.3)in 1 year postoperatively.All cases were graded as excellent results.No fracture displacement and internal fixation loosening occurred during the followup.Conclusion Non-absorbable suture cerclage combined with steel-wire binding and ring pins for comminuted fractures of patella has the advantages of reliable fixation and few complications,the comminuted pate

关 键 词：粉碎性髌骨骨折 髌骨针 线捆绑 

分 类 号：R683.42[医药卫生—骨科学]