国产超高分子聚乳酸可吸收螺钉治疗髌骨骨折术后下肢功能评定——半年随访

Evaluation of low-limb function after treatment of patellar bone fractures with domestic made poly-DL-Lactic acid absorbable screw: 6-month follow-up

目的:探讨国产超高分子聚乳酸可吸收螺钉治疗髌骨骨折的效果及安全性。方法:病例来源于2002/2003在华中科技大学同济医学院附属协和医院骨科住院的行手术切开复位超高分子聚乳酸可吸收螺钉内固定的髌骨骨折患者28例。术后第2～3天患肢置于下肢持续被动器上做持续被动屈伸功能锻炼,第5天开始进行床上练习患肢主动屈膝活动;1周后持拐下地患肢不负重行走并逐渐加大屈膝活动,术后6周可逐渐脱拐行走。术后1,2,4,12和24周进行定期随访,评定膝关节功能,观察骨折愈合时间。结果:全部病例平均随访11.7(6～20)个月。①远期膝关节功能评定:术后6个月对患者关节功能评定结果为:优17例,良9例,可2例,差0例。优良率93%。②骨折愈合时间:随访3,4个月时,患者无畸形及延迟愈合发生;股四头肌萎缩6例,术后6～12个月恢复4例,12～18个月恢复2例;无一例患者发生螺钉松动或移位。结论:超高分子聚乳酸可吸收螺钉具有良好的生物相容性及有效性;在早期能保证骨折端固定所需有强度,能达到安全、稳固牢靠的要求,且随着骨折的愈合,强度逐渐降低,和骨折愈合同步进行,不产生应力遮挡,有利于恢复骨的正常生物学结构和功能;固定强度维持时间长达6个月;最终能被人体完全吸收并排除体外。用于治疗髌骨骨折,膝关节功能恢复好,安全可靠,是髌骨骨折的理想内固定物。

AIM： To investigate the effect and safety of the treatment of domestic made poly-DL-lactic acid （PDLLA） absorbable screw on patellar bone fractures.METHODS： Between 2002 and 2003, PDLLA was used to treat 28 cases of patellar bone fractures in the Orthopaedic Department of Union Hospital affiliated to Tongji Medical College, Huazhong University of Science ＆ Technology. At 2-3 days after the operation, the operated limb was moved passively and continuously by the CPM （continue passive move） machine. The patient initiatively moved in the on the 5^th day after operation. The patient could walk with no hear by a stick and flex or extend to a larger scope a week later. After 6 weeks, the patient could walk without a stick gradually. All cases were followed up at 1, 2, 4, 12 and 24 weeks after operation and observation was done on the healing time of fractures. The functions of the knees were evaluated. RESULTS： All cases were followed up for an average of 11.7 months （6-20 months）.① The long-term functions of the knee evaluation： The results of the evaluation to the functions of the knee： excellent in 17 cases; good in 9 cases; general in 2 cases; bad in 0 cases. The excellent and good rate was 93%. ② The healing time of fracture： All the fractures had united within 3-4 months without abnormalities or delayed heal; 6 cases were quadriceps femoris atrophy and 4 cases recovered 4-6 months aftDr operation and the others recovered t2-t6 months later, no case with screw loosening or displacement. CONCLUSION： The poly-DL-lactic acid （PDLLA） absorbable screws are well biocompatible and effective. It can provide enough strength to the broken ends in the early-stage of the fractured bones. It is effective and reliable to treat all kinds of patellar fractures with safe and stable fixation. As the fracture healed, the strength of the screw decreased gradually and no stress force block created. It helps bone repair to the normal biology structure and function. The strength can maintain effectively 6 months. At last, it was absorbed and discharged out of body. It can used to treat patellar bone fracture effectively and safely and the function of knee is well. It is the ideal fixation to the patellar bone fracture.