关节镜辅助下闭合复位内固定选择性治疗髌骨骨折的临床疗效研究

Clinical efficacy study on closed reduction and internal fixation under arthroscope in the selective treatment of patellar fracture

目的探讨关节镜辅助下闭合复位内固定治疗部分髌骨骨折的临床疗效。方法 2012年1月~2015年12月在膝关节镜辅助及借助C臂监视下闭合复位,经皮克氏针张力带钢丝固定术选择性治疗髌骨骨折31例。记录患者术后恢复情况、并发症、术后疗效情况,并进行分析。结果本组随访12~28个月,平均15个月,术后14周左右均完全恢复日常生活和工作,无1例发生内固定松动及断裂等。术后根据美国特种外科医院(HSS)评分标准系统评定,优25例,良4例,可2例,优良率为93.5%。结论关节镜辅助下闭合复位内固定治疗髌骨骨折手术创伤小,生理干扰小,促进早期功能锻炼,具有并发症少及术后功能恢复快等优点,是一种值得推荐的微创内固定方式,但应把握其适应证,主要适于治疗髌骨横形、纵形骨折,不适合严重粉碎骨折,且术中仍需C臂透视监测。

Objective To investigate the clinical efficacy of closed reduction and internal fixation under arthroscope in the treatment of partial patellar fracture. Methods 31 cases of patellar fracture selectively treated by closed reduction under arthroscopy with C arm monitoring and transcutaneous Kirschner wire tension band wire fixation. The postopera- tive recovery, complications and postoperative curative effect were recorded and analyzed. Results The patients were followed up for 12 to 28 months with an average of 15 months.The daily life and work were completely restored about 14 weeks after surgery. Looseness and breakage of internal fixation in none case. According to the American Depart- merit of Special Surgery Hospital （HSS） scoring system, 25 cases were excellent, 4 cases were good, and 2 cases were tolerable,with the excellent and good rate of 93.5%. Conclusion Arthroscopy-assisted closed reduction and internal fix- ation for the treatment of patellar fractures has the advantages of small trauma, small physiological disturbance, the promotion of early functional exercise, fewer complications and quick recovery of postoperative function, which is a recommended minimally invasive internal fixation method. But its indications should be grasped and it is mainly suit- able for the treatment of patellar transverse, longitudinal fractures,but it is not suitable for serious crushing fractures. And C-arm fluoroscopy monitoring still be needed during surgery.