应用可吸收螺钉生物学特点指导髌骨骨折患者术后康复

Rehabilitation training of patellar fracture patients guided with biological characteristics of absorbable screws

目的:由于材料强度的限制,应用可吸收螺钉固定髌骨骨折术后通常需要进行外固定,结合这一特点,指导患者术后进行渐进性康复训练,观察膝关节功能恢复效果。方法:2004-06/2006-06上海交通大学附属上海市第六人民医院收治髌骨骨折患者35例,其中横型骨折27例,粉碎型骨折8例。均采用芬兰BIONX公司提供的BIOFIX(百优)自身增强聚丙交酯(SR-PLLA)可吸收螺钉治疗,术后即开始股四头肌等长收缩训练,并进行渐进性膝关节活动度训练。以膝关节功能恢复和影像检查综合判断疗效,优为膝关节功能正常,良为膝关节功能接近正常,下蹲稍差。结果:35例均完成治疗和康复,术后随访≥12个月,平均22个月。平均愈合时间为6周;疗效优29例,良6例;术后出现并发症2例,均为伤口周围红肿反应。结论:自身增强聚丙交酯可吸收螺钉治疗髌骨骨折及适当术后康复可避免二次手术,并可取得良好的治疗效果。

AIM： The limitation of materials＇ strength results in the external fixation of patients with patellar fracture following absorbable screw fixation. This study was aimed to guide the patients do progressive rehabilitation and observe the recovery of knee joint function. METHODS： Totally 35 patients with patellar fractures were enrolled from the Sixth People＇s Hospital in Shanghai Jiao Tong University between June 2004 and June 2006, including 27 cases of transverse fractures and 8 cases of comminuted fractures. They were all treated with BIOFIX self-reinforced poly-lactide absorbable screws, which were produced by Finland BIONX Company. Postoperatively isometric contraction training of quadriceps femoris was followed, and then progressive knee joint range of motion was carried out. The curative effect was evaluated by the recovery of knee joint function and radiograph. Normal knee joint function was taken as excellent effect, while nearly normal knee joint function and slightly poor squatting were taken as good effect. RESULTS： All the patients completed the treatment and rehabilitation, followed up for no less than 12 months, with a mean of 22 months. The average healing time was 6 weeks, excellent result cases were seen in 29 patients and good in 6. There was two cases occurred postoperative complications （wound swelling）. CONCLUSION： Self-reinforced poly-lactide absorbable screws for treatment of patellar fractures and appropriate postoperative rehabilitation is believed to prevent the second operations.