锁定钢板多维内固定治疗髌骨粉碎性骨折的疗效分析  

Multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates

作　　者：谢雪涛[1] 朱奕[1] 占宇[1] 李瑞扬 王驭恺 罗从风[1] Xie Xuetao;Zhu Yi;Zhan Yu;Li Ruiyang;Wang Yukai;Luo Congfeng(Department of Orthopaedic Surgery,The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华创伤骨科杂志》2022年第7期604-609,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(82072419)。

摘　　要：目的报道锁定钢板多维内固定治疗髌骨粉碎性骨折的疗效。方法回顾性研究2016年11月至2020年7月上海交通大学附属第六人民医院骨科采用切开复位锁定钢板内固定治疗的26例髌骨粉碎性骨折患者资料。男17例,女9例;年龄31~90岁,平均62.6岁。经膝关节前正中纵形切口显露并复位髌骨骨折,用环扎钢丝初步固定,将经过修剪和塑形的3.5 mm锁定钢板贴在髌骨表面上,分别从髌骨下极向上极、从前向后和从外侧向内侧置入锁定螺钉,实施多维固定。随访时评估B?stman评分、膝关节疼痛视觉模拟评分(VAS)、放射学影像和骨折愈合情况、膝关节主动活动度和并发症等。结果26例患者均获随访,时间12~56个月(平均28个月);术后1~3个月(平均1.6个月)脱拐行走。末次随访时B?stman评分为17~30分(平均27.5分),优12例,良13例,差1例,优良率为96.2%(25/26);膝关节疼痛VAS评分0~5分,平均1.2分;膝关节主动屈曲100°~150°,平均125°;未出现钢板和螺钉松动、移位或断裂。11例患者发生环扎钢丝断裂,但没有症状;4例患者主诉内置物刺激,4例患者骨折愈合后取出所有内置物。结论锁定钢板多维内固定治疗髌骨粉碎性骨折技术可行,疗效满意。Objective To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery,The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University.There were 17 males and 9 females,with an average age of 62.6 years(from 31 to 90 years).The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee.After the reduction was initially maintained with a cerclage wire,a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface.After-wards,locking screws were inserted from the lower pole to the upper pole of the patella,from the anterior to the posterior and from the lateral to the medial,respectively,to complete the multi-planar fixation.Follow-ups assessed the Böstman score,knee pain visual analogue scale(VAS),radiographic image and fracture healing,range of motion of the knee,and complications.Results All the 26 patients were followed up for 12 to 56 months(average,28 months).Crutches were used while walking until an average of 1.6 months(from 1 to 3 months)after operation in all patients.At the last follow-up,the Böstman score averaged 27.5 points(from 17 to 30 points),yielding 12 excellent,13 good and 1 poor case with an excellent to good rate of 96.2%(25/26);the knee pain VAS averaged 1.2 points(from 0 to 5 points);the active knee flexion averaged 125°(from 100°to 150°).No breakage,loosening or displacement of the patellar plates or screws was observed during follow-up,but cerclage wire breakage occurred without any symptom in 11 cases.Four patients complained of hardware irritation,and 4 patients underwent hardware removal after fracture union.Conclusion Multi-dimensional fixation with locking plates is a viable

关 键 词：髌骨 骨折 骨折固定术 内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]