形状记忆合金髌骨爪置入治疗髌骨骨折121例资料回顾

Shape memory alloy clamp for patellar fractures: Retrospective analysis of 121 cases

背景：既往一般采用丝线或钢丝环扎、克氏针张力带钢丝及改良AO张力带、螺钉等固定方法治疗髌骨骨折，其手术创伤大，影响髌骨血供，骨折愈合慢，易发生关节功能受限。目的：分析Ti-M形状记忆合金髌骨爪治疗髌骨骨折的疗效。设计、时间及地点：回顾性病例分析，2001—06／2006—06洛阳正骨医院。对象：髌骨骨折患者121例123膝，男78例80膝，女43例43膝。年龄21～67岁，平均38．3岁。左侧47例，右侧72例，双侧2例。其中横断型骨折53膝，粉碎性骨折36膝，撕脱型骨折32膝，纵裂形骨折2膝。直接暴力23例，间接暴力98例。方法：患侧髌前直切151，显露骨折端，保留深层髌前腱膜。复位骨折，缝合两侧撕裂的髌旁支持带及髌前腱膜。测量髌骨纵径，将大小合适的髌骨爪各枝经股四头肌腱及髌韧带切口置于已复位好的髌骨上。复位满意后，用温盐水纱布热敷，使髌骨爪迅速复位至原设计形状。依次闭合切口。主要观察指标：①材料与宿主的生物相容性反应。②采用Bostman髌骨骨折疗效评定标准进行功能评价。结果：121例患者均获得随访，平均随访8个月。所有骨折均愈合，无伤口感染发生。4例术后出现骨折的轻度移位，1例出现早期创伤性关节炎的表现，2例出现上极髌骨爪部分滑脱。功能评价：优107膝，良16膝。结论：应用Ti—Ni形状记忆合金髌骨爪复位、固定髌骨骨折，固定可靠，保留的髌骨软组织面，对于维持髌骨的血供有重要意义，加速了骨折的愈合。

BACKGROUND： Suture silk or steel ring, Kirschner wire tension wire, modified AO band and screw are always used to treat patellar fractures. These methods cause large wound, slow fracture healing and limited joint function. OBJECTIVE： To analyze the therapeutic effect of Ti-Ni shape memory alloy clamp on patellar fractures. DESIGN, TIME AND SETTING： Retrospective analysis was performed at the Luoyang Hospital of Orthopedics and Traumatics from June 2001 to June 2006. PARTICIPANTS： 121 patients of patellar fractures （123 knees）, 78 males （80 knees） and 43 females （43 knees）, aged 38.3 years （range 21-67 years）. There were 47 cases with left patellar fracture, 72 cases with right and 2 with bilateral; 53 knees were transverse, 36 knees were comminuted, 32 avulsion, and 2 vertical fracture; 23 cases were injured by direct violence, and 98 by indirect violence. METHODS： Vertical incisions were made to expose fractures. The deep layer of the tendinous membrane was remained. The fracture was repositioned and the lacerated retinaculum and tendinous membrane were sutured. After the vertical diameter of the patella was measured, suitable clamp was selected and placed. After well repositioned, heat saline gauze was used to make the clamp reposition and fix the fractures. The incision was finally closed. MAIN OUTCOME MEASURES： Material and host responses; functional assessment of the patella fractures using Bostman. RESULTS： 121 cases were followed-up for 8 monthsS. All fractures were healed. No infection occurred. A little displacement of fractures occurred in 4 cases, early traumatic arthritis in 1 case, and slippage of the clamps in 2 cases. According to the functional assessment of the patella fractures of Bostman, the excellent results were 107 knees, and good were 16 knees. CONCLUSION： Ti-Ni shape memory alloy clamps exhibit reliable fixation, with soft tissue remaining, which is important to retain the blood supply of the patella. Moreover, it accelerates the healing of fractures.