5种方法治疗髌骨骨折164例

Treatment of patella fractures of 164 patients with 5 methods

目的:探讨根据髌骨骨折的具体情况采用不同的治疗方法,并对临床结果进行分析。方法:回顾性分析2005年7月至2009年12月收治髌骨骨折164例,男113例,女51例;年龄21～72岁,平均38.5岁。摔伤80例,车祸伤73例,击打伤11例。线性骨折或髌骨分离<0.5cm者21例,髌骨分离>0.5cm且为单纯横行或纵行骨折者63例,髌骨分离为3块者34例,分离为4块及以上者46例。其中保守治疗21例,钢丝环扎加"8"字内固定术治疗39例,空心钉及张力带钢丝内固定术治疗43例,经皮空心钉内固定术治疗29例,镍钛聚髌器内固定术治疗32例。结果:164例均获随访,时间3～36个月,平均14个月。按Lysholm膝关节评分标准:保守治疗优良19例,钢丝环扎加"8"字内固定优良36例,空心钉及张力带钢丝内固定优良40例,经皮空心钉内固定优良27例,镍钛聚髌器内固定优良30例。结论:能手法整复、固定者,尽量避免手术;需要手术治疗者应根据骨折类型选择不同的术式,可以经皮复位固定的,尽量微创手术;不管保守治疗还是手术内固定,都需要尽早进行合适的功能锻炼。

Objective：To investigate the effects of different treatments for different patella fractures,and analyze the clinical outcome.Methods：One hundred and sixty four patients with patella fracture were treated between July 2005 and December 2009,113 males and 51 females with an average age of 38.5 years old,ranging from 21 to 72 years.There were 21 cases of linear fracture or separation of the patella0.5 cm,63 of patella separation0.5 cm and for the pure horizontal type or vertical type fractures,34 cases were separated into three block,46 cases were separated into four and above.Of 164 cases,21 patients accepted traditional treatment,39 patients were fixed with cerclage wire and tension band wire,43 with cannulated screws and tension band wire fixation,29 with cannulated screws for the minimally invasive treatment,32 patients with fixation of NT-PC Results：One hundred and sixty four cases were followed up with a mean period of 14 months（3 to 36 months）.By Lysholm knee score criteria：19 cases in traditional treatment were excellent and good,36 cases in cerclage wire and tension band wire technique cases were excellent and good,40 cases in cannulated screws and tension band wire fixation,27cases in cannulated screws for the minimally invasive treatment were excellent and good,30 cases in NT-PC were excellent and good.Conclusion：The surgery should be avoid if the patients can be treated with manipulation and fixation.Those who need surgical treatment should be based on the type of fracture to select a different surgical operation.Percutaneous reduction can be fixed,and try to minimally invasive surgery.Whether traditional treatment or internal fixation,the appropriate functional exercise need to make as early as possible.