关节镜辅助经皮螺丝钉内固定与切开复位记忆爪内固定治疗髌骨骨折:两种植入体材料物理性能与修复效果的关系

Percutaneous screws under arthroscope and nickel-titanium patellar concentrate claw in the treatment of patellar fracture:Correlation between physical performance and repair effect of the two implants

目的:观察膝关节镜辅助经皮螺丝钉内固定与切开复位髌骨爪内固定两种植入体材料特征及治疗髌骨骨折的疗效,探讨植入体选择与其效果的相关性。方法:①试验对象:选择2001-11/2005-12本院在膝关节镜下经皮复位螺丝钉内固定治疗髌骨骨折30例做为镜下组,选骨折类型相似的患者切开复位髌骨爪内固定治疗髌骨骨折30例做为髌骨爪组。所有患者术前签知情同意书及手术同意书。②试验方法:镜下组在关节镜下闭合复位,用两枚平行螺丝钉内固定;髌骨爪组切开复位,用记忆合金髌骨爪内固定。③试验评估:根据胥少汀等评分法评价膝关节功能并在术后进行随访观察。结果:①术后嘱患者按1,3,6,12个月门诊复诊,随访9～13个月,平均12个月。②两组患者术后随访优良率:镜下组优22例(73%),良7例(23%),可1例(3%);髌骨爪组优21例(70%),良7例(23%),可1例(3%),差1例(3%)。③镜下组与髌骨爪组平均出血量分别为(30±14),(100±50)mL;手术时间(60±15),(80±15)min,住院时间(8±2),(16±3)d,差异显著(P<0.01)。结论:两种方法术后关节功能恢复均良好,关节镜下经皮螺丝钉内固定治疗髌骨骨折创伤小、出血少、复位确切、有利于术后关节早活动。

AIM： To evaluate the effectiveness of arthroscopic-assisted surgical technique for treating patella fractures by percutaneous screws and open to replace by nickel-titanium patellar concentrate （NT-PC） claw and study the relation between different implantation and the effect. METHODS： ①Totally 30 patellar fracture patients treated with percutaneous screws as percutaneous screws group and 30 patellar fracture patients treated with NT-PC claw as NT-PC claw group were enrolled from November 2001 to December 2005. All subjects signed the informed consent.②Patients of the percutaneous screws group received closed reduction and internal fixation with two paralleled percutaneous screws under arthroscope. Patients of the NT-PC claw group received open reduction and internal fixation with NT-PC claw. ③Knee joint function was followed up according to Xu Shaoting＇s standard. RESULTS： ①Outpatient clinic return visit was performed at months 1, 3, 6 and 12 after operation, for 9-13 months, averagely 12 months. ②Twenty-two cases were excellent （73%）, 7 cases were good （23%）, 1 case was fair （3%） in the percutaneous screws group. Twenty-one cases were excellent （70%）, 7 cases were good （23%）, 1 case was fair （3%） and 1 case was poor （3%） in the NT-PC claw group. ③Mean bleeding amount was （30±14） mL and（100±50）mL, and timing of operation was （60±15） minutes and （80±15） minutes, and length of stay was （8±2） days and （16±3）days in the patients of percutaneous screws group and NT-PC claw group, respectively （ P 〈 0.01 ）. CONCLUSION： The two methods for repainng joint function can have good effects. Treatment of patellar fractures by percutaneous screws under the arthroscope is a minimal invasive technique with less bleeding, accurate reduction and early postoperative joint activity.