免激惹张力带技术治疗髌骨下极骨折  

Treatment of patella inferior pole fracture with non excitation tension band technique

作　　者：李春江[1] 王保苍 王斌[1] 冯晓娜[1] 尹佳丽[1] 史伟 于泽洋[1] 张荐[1] 周立健 Li Chunjiang;Wang Baocang;Wang Bin;Feng Xiaona;Yin Jiali;Shi Wei;Yu Zeyang;Zhang Jian;Zhou Lijian(The Emergency Department,Second Hospital of Tangshan,Tangshan 063000,China;Tangshan Concord Hospital,Tangshan 063000,China;Tangshan Nanpu Development Zone Hospital,Tangshan 063000,China)

机构地区：[1]唐山市第二医院急诊科,063000 [2]唐山市协和医院,063000 [3]唐山市南堡开发区医院,063200

出　　处：《中华骨科杂志》2021年第24期1776-1784,共9页Chinese Journal of Orthopaedics

摘　　要：目的探讨免激惹张力带技术治疗髌骨下极骨折的可行性及治疗效果。方法收集2009年4月至2019年12月采用免激惹张力带技术治疗76例髌骨下极骨折患者资料,其中男42例,女34例;年龄(35.48±18.12)岁(范围17~66岁);左侧45例,右侧31例。致伤原因:摔伤46例,自行车伤16例,车祸伤14例。受伤至手术时间0.25~5 d,平均3.2 d。开放性骨折18例,累及关节面骨折64例,粉碎性骨折52例。开放性骨折患者首先清创,所有病例均采用免激惹张力带技术固定。观察术中骨折复位、术后骨折愈合及内固定状态,根据跛行程度、支撑物使用情况、有无关节绞锁感、关节不稳定情况、疼痛、肿胀度、楼梯攀爬及下蹲等情况评价膝关节功能。结果76例患者均顺利完成手术,且均获得随访,随访时间(18.24±6.18)个月(范围12~24个月)。术中及术后均无钢丝断裂;术后切口均Ⅰ期愈合,无下肢深静脉血栓形成。复查X线片显示术后无再骨折、骨折移位,内固定取出前无克氏针滑移,仅1例由于卡扣原因致钢丝松弛(未影响骨折愈合)。所有骨折均愈合良好,平均7.5周骨折线基本消失。术后12个月根据Lysholm膝关节评分标准对患者进行膝关节功能评定,76例评分为(95.40±4.60)分(范围82~100)分:优54例,良21例,可1例,优良率98.7%。根据视觉模拟评分法(visual analogue scale,VAS)76例评分为(0.09±2.05)分(范围0~3)分,其中4例有轻度疼痛感觉,平均得分0.09分。结论免激惹张力带技术治疗髌骨下极骨折疗效满意,内固定物对周围组织刺激引起的疼痛感低,临床可以推广应用。Objective:To explore the experience of the treatment of patella inferior pole fracture with non excitation tension band technique.Methods:From April 2009 to December 2019,76 patients with inferior patellar fracture were treated with non excitation tension band technique.There were 42 males and 34 females;The age was 35.48±18.12 years(17-66 years),with an average of 35 years.There were 45 cases on the left and 31 cases on the right.Causes of injury:fall injury in 46 cases,bicycle injury in 16 cases and traffic accident injury in 14 cases.The time from injury to operation was 0.25-5 d,with an average of 3.2 d.There were 18 cases of open fractures,64 cases of articular surface fractures and 52 cases of comminuted fractures.Open fracture patients were debridement first,and all cases were fixed with non excitation tension band technique.The intraoperative fracture reduction,postoperative fracture healing and internal fixation were observed.The knee function was evaluated according to the degree of claudication,the use of supports,the feeling of joint strangulation,joint instability,pain,swelling,stair climbing and squatting.Results:All 76 patients successfully completed the operation and were followed up for 18.24±6.18 months(range 12-24 months).There was no wire fracture during and after operation.All incisions healed in the first stage after operation,and there was no deep venous thrombosis of lower limbs.The X-ray film showed that there was no further fracture and fracture displacement after operation,and there was no Kirschner wire slip before the internal fixation was taken out.Only one case had steel wire relaxation due to buckle(which did not affect fracture healing).All fractures healed well,with an average of 7.5 weeks,and the fracture line basically disappeared.12 months after operation,according to Lysholm knee score standard,the knee function of patients was evaluated.The score of 76 cases was 95.40±4.60 points(range 82-100 points):excellent in 54 cases,good in 21 cases and fair in 1 case.The excellent

关 键 词：髌骨 骨折 骨折 粉碎性 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]