垂直钢缆环状捆绑固定治疗髌骨下极粉碎性骨折  

Vertical steel cable circular binding fixation for fractures of the lower pole of the patella

作　　者：王丙刚[1] 刘娜[2] Wang Binggang;Liu Na(Department of NO.5 Trauma,the Second Hospital of Tangshan,Tangshan,Hebei 063000,China;Department of NO.1 Joint,The Second Hospital of Tangshan,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院创伤五科,河北唐山063000 [2]唐山市第二医院关节一科,河北唐山063000

出　　处：《创伤外科杂志》2023年第6期448-452,共5页Journal of Traumatic Surgery

摘　　要：目的 探讨垂直钢缆环状捆绑固定在髌骨下极粉碎性骨折治疗中的临床疗效。方法 回顾性分析2016年10月—2020年2月唐山市第二医院应用垂直钢缆环状捆绑固定治疗的髌骨下极粉碎性骨折患者27例,男性15例,女性12例;年龄19~73岁,平均46.9岁;走路摔伤11例,跑步摔伤2例,骑自行车摔伤7例,骑电动车摔伤1例,道路交通伤4例,高处摔伤2例;骨折部位:左侧17例,右侧10例;患者均为闭合性骨折。记录术中出血、伤口长度、手术时间、术后疼痛视觉模拟评分(vsual analog scale, VAS)、膝关节活动度、术中与术后1年髌骨的Caton-Deschamps指数、骨折复位程度、骨折愈合时间等,评估治疗效果。结果 患者获12~24个月随访,平均15.2个月;术中平均出血61.1mL;伤口平均长度5.3cm;手术平均时间49.3min;术后VAS5.5分;膝关节活动范围126.3°;髌骨术中Caton-Deschamps指数0.9±0.2,术后1年0.9±0.1,两者比较差异无统计学意义(t=0.174,P=0.863);骨折复位程度评估0.03mm,术后1年0.02mm;骨折愈合时间2.8个月。骨折均获得骨性愈合,伤口愈合良好,无感染,无疼痛、无钢缆刺激软组织引起的不良反应,膝关节活动度恢复正常,术后膝关节稳定。临床膝关节功能采用B9stman评分体系进行疗效评估,其中优20例,良7例。结论 垂直钢缆环状捆绑固定治疗髌骨下极骨折,手术时间短,不影响髌骨位置,骨折固定结实可靠,膝关节功能恢复良好,无软组织激惹,是治疗髌骨下极骨折的有效方法之一。Objective To explore the clinical effects of vertical steel cable circular binding fixation in the treatment of comminuted fractures of the lower pole of the patella.Methods A retrospective analysis was conducted on the data of 27 cases of comminuted patellar fractures treated with vertical steel cable circular binding fixation at the Second Hospital of Tangshan from Oct.2016 to Feb.2020,including 15 males and 12 females aged 19-73 years,mean 46.9 years.There were 11 falls at walking,2 falls at running,7 falls at bike riding,I falls at electric bike,4 road traffic injuries and 2 falls from height.All of the 27 cases had closed fractures,with 17 on the left and 10 on the right.Intraoperative bleeding,wound length,surgical time,visual analog scale(VAS)for postoperative pain,knee joint range of motion,Caton-Deschamps index of the patella during and one year after surgery,quality of fracture reduction,and fracture healing time were recorded and used to evaluate the treatment outcome.Results All patients were followed up for 12-24 months,mean 15.2 months.On average,the intraoperative bleeding was 61.1 mL,wound length 5.3 cm,surgical time 49.3 min,postoperative VAS 5.5,and range of motion of the knee joint 126.3°.The Caton-Deschamps index was 0.9±0.2 intraoperatively and 0.9±0.1 at one year after surgery,revealing no statistically significant difference(t=0.174,P=0.863).The degree of fracture reduction was evaluated as 0.03 mm,the degree of reduction loss was evaluated as 0.02 mm at 1 year after surgery.All fractures achieved good bone union within an average of 2.8 months,without any infection,pain,or discomfort caused by soft tissue stimulation by steel cables.After surgery the knee joint was stable and the range of motion returned to normal.The Böstman scoring system was used to assess its function,which showed 20 cases being excellent and 7 good.Conclusion Vertical steel cable circular binding fixation is an effective technique to manage patellar distal fractures,which shows a short surgical time,no influence o

关 键 词：髌骨下极骨折 钢缆捆绑 髌骨骨折 

分 类 号：R683.42[医药卫生—骨科学]