钢丝环扎加空心钉张力带治疗髌骨骨折

Treatment of patella fracture with circumferential wiring plus cannulated lag screws tension band

目的探讨钢丝环扎加空心钉张力带治疗髌骨Regazzoni B型骨折的临床效果。方法2006年1月至2008年5月,运用钢丝环扎加空心钉张力带技术治疗髌骨骨折41例。根据Regazzoni分型,B1型11例,B2型21例,B3型9例。其中女25例,男16例,年龄45～86岁,平均58.8岁。所有患者均为闭合性损伤,直接暴力12例,间接暴力29例。切开复位后屈曲膝关节,直径0.8钢丝环扎后,二根1mm导针经髌骨上极或下极平行钻入,然后选择4.0mm半螺纹自攻空心螺钉沿导针拧入,最后经空心钉以"8"字的方式穿入钢丝,并拧紧完成张力带结构。术后第3天指导患者被动伸屈锻炼。结果38例患者均获平均8个月的随访,3例失随访。平均愈合时间6.5周。所有患者无伤口感染、内固定松动、骨折再移位等并发症,16例发生轻微软组织激惹,无一例患者因内固定原因行内固定取出术。采用Bstman髌骨骨折疗效评分标准于骨折愈合后2周进行伤侧膝关节功能评定,其中优32例,中6例。结论钢丝环扎加空心钉张力带治疗髌骨骨折,固定效果可靠,软组织激惹和固定失败率低。

Objective To investigate the clinical effects of patella fractures treated with circumferential wiring plus cannulated lag screws tension band.Methods From January 2006 to May 2008,41 cases of patella fractures were treated with circumferential wiring plus cannulated lag screws tension band.25 females and 16 males,ages ranged from 45 to 86 years old（average 58.8）.According to Regazzoni patella fracture classification,there were 11 type B1,21 type B2,and 9 type B3 fractures.Direct force 12 cases,indirect force 29 cases.After open reduction,fractures were first fixed with circumferential wires（diameter 0.8 mm）,and then two parallel K-wires were inserted from proximal bottom or distal pole across the fracture line,followed by two 4.0 mm cannulated lag screws respectively.Then 0.6 mm wire was passed through two screws canal to create a figure-eight pattern tension band on the anterior surface of patella.Results 38 cases were followed-up for a mean of 8 months.3 cases were lost.All fractures were healed without complications such as incision infection,loosening of fixation.16 cases had light soft tissue irritation.No patient was removed the fixation due to implants.The mean healing time was 6.5 weeks.32 cases were good,6 were fair according to Bstman’s knee joint functional scale of patella fracture 2 weeks after fracture healing.Conclusion Circumferential wiring plus cannulated screw tension band is a reliable fixation for patella fracture.