髌骨骨折内固定术中判断内外侧关节面复位质量的新透视方法  

A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation

作　　者：王伟斌[1] 韩欣攸 扶青松 袁欣华[1] 张世民 WANG Weibin;HAN Xinyou;FU Qingsong;YUAN Xinhua;CHANG Shimin(Department of Orthopaedic Trauma,Ningbo No.2 Hospital,Ningbo Zhejiang,315010,P.R.China;Department of Orthopaedics,Yangpu Hospital,Tongji University School of Medicine,Shanghai,200090,P.R.China)

机构地区：[1]宁波市第二医院创伤骨科,浙江宁波315010 [2]同济大学附属杨浦医院骨科,上海200090

出　　处：《中国修复重建外科杂志》2024年第7期836-841,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宁波市第二医院“朱绣山先生人才奖励基金”人才项目(2023HMJQ08)。

摘　　要：目的介绍一种髌骨骨折内固定术中判断内外侧关节面复位质量的新透视方法,并总结采用该方法治疗的髌骨骨折患者临床疗效。方法回顾性分析2018年1月—2022年1月收治且符合选择标准的52例髌骨骨折患者临床资料。其中男27例,女25例;年龄21~75岁,平均62岁。髌骨骨折类型:横形骨折9例,粉碎性骨折37例,纵向骨折6例。根据国际内固定研究协会/美国骨创伤协会(AO/OTA)2018年版分型标准,34A型21例、34B型6例、34C型25例。受伤至手术时间1~5 d,平均2.3 d。采用空心钉或空心钉张力带伴或不伴锚钉修复内固定治疗,术中采用髌骨内外侧关节面切线透视法,观察髌骨中嵴关节面、外侧关节面、内侧关节面以及外侧关节面边缘的复位平整度及内固定物位置。术后定期随访并摄X线片观察骨折愈合情况,采用膝关节活动度、Böstman评分和Lysholm评分评价功能恢复情况。结果术中采用髌骨内外侧关节面切线透视法示内外侧关节面均复位满意,内固定物位置均良好。所有患者均获随访,随访时间12~16个月,平均13.4个月。随访期间发生骨折移位1例,钛缆断裂1例。髌骨骨折均顺利愈合,愈合时间8~16周,平均11.4周。末次随访时膝关节活动度达120°~140°,平均136°。Böstman评分为20~30分,平均28分;获优45例、良7例。Lysholm评分88~100分,平均93分;获优40例、良12例。结论应用髌骨内外侧关节面切线透视法术中可以快速确定髌骨的透视平面,准确评估骨折复位质量及内固定物位置,进而提升临床疗效。Objective To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method.Methods A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria.There were 27 male and 25 female patients,aged 21-75 years,with an average age of 62 years.The types of patellar fractures included 9 transverse fractures,37 comminuted fractures,and 6 longitudinal fractures.According to the AO/Orthopaedic Trauma Association(AO-OTA)-2018 fracture classification,there were 21 cases of type 34A,6 cases of type 34B,and 25 cases of type 34C.The time from injury to operation ranged from 1 to 5 days,with an average of 2.3 days.Treatments included internal fixation with hollow screws or hollow screw tension bands,with or without anchor repair.During operation,the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge,lateral joint surface,medial joint surface,and lateral joint edge.Patients were followed up regularly,and X-ray films were taken to observe fracture healing.Knee joint range of motion,Böstman score,and Lysholm score were used to evaluate functional recovery.Results The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants.All patients were followed up 12-16 months,with an average of 13.4 months.During the follow-up,fracture displacement occurred in 1 case and titanium cable breakage in 1 case.All patella fractures healed successfully,with a healing time of 8-16 weeks(mean,11.4 weeks).At last follow-up,knee joint range of motion ranged from 120°to 140°,with an average of 136°.The Böstman score ranged from 2

关 键 词：髌骨骨折 术中透视 关节面 骨折复位 

分 类 号：R687.3[医药卫生—骨科学]