老年髌骨粉碎性骨折的固定方法探讨

Operative treatment of displaced fracture of patella in the elderly

目的评价髌骨张力带内固定术、钢丝"8"字固定+四周环抱术、部分切除术及改良式部分髌骨切除术治疗老年移位性髌骨骨折的疗效。方法59例老年移位性髌骨骨折,其中24例髌骨中部横断骨折,采用张力带内固定术;16例髌骨粉碎骨折采用钢丝"8"字固定+四周环抱,5例髌骨下极骨折采用髌骨部分切除术;11例髌骨下极骨折和3例上极骨折采用改良式部分髌骨切除术。结果术后随访2～6年,按陆裕朴评定标准,张力带内固定术组:优18例,良3例,可3例;钢丝"8"字固定+四周环抱术组:优12例,良1例,可3例;部分切除术组:可3例,差2例;改良式部分髌骨切除术组:优13例,良1例。结论张力带内固定术与钢丝"8"字固定+四周环抱术是治疗老年移位性髌骨骨折的有效方法,治疗关键是解剖复位、稳妥固定及早期非负重功能锻炼。

Objective To investigate the clinical effects of tension band internal fixation of patella , ＂8＂ modality steel wair and circled enlaced fixation of patella , partial patellectomy and modified partial patellectomy on displaced fracture of patella in the elderly. Methods Of 59 old patients with displaced fracture of the patella ,24 with transverse at the middlepart of patella were treated with tension band internal fixation ;16 with comminuted fracture were treated with ＂8＂ modality steel wair and circled enlaced fixation; 5 of inferiorpolar fracture of patella were treated with partial patellectomy and the other 11 with inferior polar fracture of patella and 3 with superion polar fracture of patella were treated with modified partial patellectomy. Results The follow-up period ranged from 2 to 6 years. According to Lu＇s evaluation standards ,there were 18 excellent cases,3 good and 3 fair in tension band internal fixation group; 12 excellent cases,1 good and 3 fair in the fixation of ＂8＂ modality steel wair and circled enlaced; 3 fair and 2 poor in partial patellectomy group;13 excellent and 1 good in modified partial patellectomy. Conclusion The tesion band internal fixation and the ＂8＂ modality steel wair and circled enlaced fixation are the effective methods to treat the displaced fracture of the patelle in the elderly. The key points of success are anatomic reduction ,stable fixation and early functional exercises under non-weight bearing conditions.