髌骨下极骨折:一种新的微创治疗方法及其临床疗效分析  

Fracture of the lower pole of patella:a new minimally invasive treatment and analysis of its clinical efficacy

作　　者：王海鹏 梁立卓 王璞 陈垂继 董川 马保安 王育才 Wang Haipeng;Liang Lizhuo;Wang Pu;Chen Chuiji;Dong Chuan;Ma Baoan;Wang Yucai(Department of Orthopedics,The Second Affiliated Hospital,Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学第二附属医院(唐都医院)骨科,西安710038

出　　处：《创伤外科杂志》2022年第8期596-601,共6页Journal of Traumatic Surgery

基　　金：陕西省创新能力支撑计划资助项目(2021TD-45)。

摘　　要：目的比较髌骨下极骨折采用“糖果包”-锚合微创技术与传统治疗技术的临床疗效。方法回顾性研究空军军医大学唐都医院骨科2019年6月—2021年6月采用“糖果包”-锚合微创技术治疗髌骨下极骨折患者27例(新技术组),其中男性17例,女性10例;年龄25~63岁,平均47.6岁;左侧12例,右侧15例;致伤原因:摔跌伤14例,道路交通伤8例,刀砍伤1例,运动伤2例,重物砸伤2例。并与2018年1月—2019年5月本研究团队使用传统技术治疗髌骨下极骨折24例患者进行比较(传统组)。比较两组手术时长、初始下地负重锻炼时间、术后6个月髋部骨折的影像愈合评价系统(RUSH)评分、末次复查时患膝B stman评分、术后并发症发生率。结果门诊随访10~16个月,平均12.6个月。51例患者均获得骨性愈合,骨折愈合时间平均12.3周(12~16周)。两组术后6个月复查RUSH评分比较差异无统计学意义[(27.1±1.5)分vs.(26.7±1.8)分,P=0.227]。新技术组与传统组手术时间[(57.6±7.7)min vs.(79.4±11.2)min]、初始负重锻炼时间[(1.4±0.3)d vs.(7.8±3.7)d]、终末期患膝功能B stman评分[(28.6±1.3)分vs.(25.4±2.6)分]比较差异均有统计学意义(P<0.05)。新技术组出现1例切口脂肪液化、软组织克氏针激惹,发生率4%;传统组出现2例张力钢丝滑脱、内固定失效、骨折复位丢失,2例制动后关节僵硬,1例下极内固定线性切割致骨块撕脱、骨折不愈合,1例伤口感染、内固定外露,发生率25%,新技术组术后并发症发生率显著低于传统组(P=0.042)。结论“糖果包”-锚合技术治疗髌骨下极骨折相较于传统手术方法手术时间短、创伤小、操作简洁、固定可靠、临床疗效良好,值得临床推广应用。Objective To compare the clinical efficacy of"candy package-anchor combined"minimally invasive technique with traditional technique in the treatment of inferior patellar fracture.Methods A total of 27 cases of inferior patellar fractures treated with"candy package-anchor combined"minimally invasive technique in the Department of Orthopaedics,The Second Affiliated Hospital,Air Force Medical University from Jun.2019 to Jun.2021 were retrospectively reviewed and were classified to new-technology group.There were 17 males and 10 females,aged 25-63 years,with an average of 47.6 years.There were 12 cases on the left and 15 cases on the right.There were 14 cases of falling injury,8 cases of road traffic accident injury,1 case of knife cut injury,2 cases of sports injury and 2 cases of heavy object hit injury.Totally 24 patients with patellar inferior pole fracture treated by our research team using traditional surgical techniques from Jan.2018 to May 2019 were classified to traditional group.The duration of operation,the out-of-bed weight-bearing time,the RUSH(Radiographic Union Score for Hip Fractures)score at 6 months after surgery,the B stman score of the knee during the last follow-up and the incidence of postoperative complications were evaluated and compared between the two groups.Results All patients were followed up for 10-16 months after surgery,with an average of 12.6 months.All 51 patients finally achieved radiographic bone union,and the average clinical healing time was 12.3 weeks(12-16 weeks).There was no significant difference in the RUSH score between the new-technology group and the traditional group at 6 months after surgery[(27.1±1.5)points vs.(26.7±1.8)points],P=0.227.While the new-technology group performed better than the traditional group in operation time[(57.6±7.7)minutes vs.(79.4±11.2)minutes,P=0.025],out-of-bed weight-bearing time[(1.4±0.3)days vs.(7.8±3.7)days,P<0.001]and B stman score of end-stage knee function[(28.6±1.3)points vs.(25.4±2.6)points,P<0.001].As to the incidence of posto

关 键 词：髌骨下极骨折 微创 “糖果包”-锚合固定技术 内固定 

分 类 号：R683.42[医药卫生—骨科学]