髌骨骨折镍钛记忆合金髌骨爪内固定术后内固定失效原因分析及应对措施  

Analysis of reasons for internal fixation failure after internal fixation of patella fracture with nickel-titanium memory alloy patella claw and its countermeasures

作　　者：梁海松 邓煜[1] 惠小苏[2] 白新文[1] 盛东 姜仁建[3] LIANG Haisong;DENG Yu;HUI Xiaosu;BAI Xinwen;SHENG Dong;JIANG Renjian(Second Orthopedic Ward,Chongqing Orthopedic Hospital of Traditional Chinese Medicine,Chongqing 400010,P.R.China;Department of Anorectal,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400000,P.R.China;Department of Orthopedics,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400000,P.R.China)

机构地区：[1]重庆市中医骨科医院骨伤二病区,重庆400010 [2]重庆市中医院肛肠科,重庆400000 [3]重庆市中医院骨科,重庆400000

出　　处：《华西医学》2021年第10期1361-1365,共5页West China Medical Journal

基　　金：重庆市技术创新与应用发展专项面上项目(cstc2019jscx-msxmX0229)。

摘　　要：目的分析髌骨骨折镍钛记忆合金髌骨爪内固定术后内固定失效原因,并探讨其应对措施。方法回顾性分析2015年5月—2020年4月重庆市中医骨科医院骨伤二病区采用镍钛记忆合金髌骨爪内固定治疗的髌骨骨折患者临床资料,找出术后内固定失效患者,分析内固定失效的原因。结果共纳入患者436例,10例患者发生内固定失效,其中6例(1.38%)为髌骨爪滑脱,4例(0.92%)为单纯骨折块移位伴关节面移位≥2 mm。内固定失效发生在术后4~48 d,平均(18.20±10.86)d。分析显示,4例患者内固定失效的原因为术后早期功能锻炼不当,3例为未选择辅助内固定物,2例为髌骨爪型号偏小,1例为辅助内固定物固定不恰当。结论髌骨骨折镍钛记忆合金髌骨爪内固定术后内固定失效主要与髌骨爪型号是否合适、有无选择辅助内固定物、辅助内固定物是否固定恰当、术后早期功能锻炼是否恰当有关。Objective To analyze the reasons for internal fixation failure after internal fixation of nickeltitanium memory alloy patella claw for patella fracture,and to explore the countermeasures.Methods The clinical data of patients with patellar fracture treated by internal fixation of nickel-titanium memory alloy patella claw in the Second Orthopedic Ward of Chongqing Orthopedic Hospital of Traditional Chinese Medicine from May 2015 to April 2020 were analyzed retrospectively.Patients with postoperative internal fixation failure were identified.The reasons for internal fixation failure were analyzed.Results A total of 436 patients were included.Internal fixation failure occurred in 10 patients.There were 6 cases(1.38%)of patellar claw detachment,and 4 cases of simple fracture block displacement with articular surface displacement≥2 mm(0.92%).Internal fixation failure occurred 4 to 48 days postoperatively,with an average of(18.20±10.86)days.The analysis showed that the reason for internal fixation failure in 4 patients was improper early postoperative functional exercise.The reason for 3 patients was that the auxiliary internal fixation was not selected.The reason for 2 patients was that the size of the patellar claw was too small.The reason for 1 patient was the improper fixation of the auxiliary internal fixation.Conclusion The failure of internal fixation after patella fracture with nickeltitanium memory alloy patella claw is mainly related to whether the model of the patella claw is appropriate,whether the auxiliary internal fixation is selected,whether the auxiliary internal fixation is properly fixed,and whether the early postoperative functional exercise is appropriate.

关 键 词：髌骨骨折 髌骨爪 内固定失效 

分 类 号：R687.3[医药卫生—骨科学]