带线锚钉治疗急性髌骨下极撕脱性骨折

Suture anchors fixation in the treatment of acute distal avulsion fracture of patella

目的 探讨带线锚钉技术治疗急性髌骨下极撕脱性骨折的方法和临床疗效.方法 2007年1月至2009年7月,采用采用5.0 mm Twinfix带线锚钉治疗33例急性髌骨下极撕脱性骨折患者,男18例,女15例;年龄28～72岁,平均49.3岁;伤后至手术时间2～7 d,平均3.5 d.致伤原因：交通事故12例,摔伤11例,运动创伤9例,无明确外伤病史1例.采用Bostman髌骨骨折功能评分,临床评估为术后Bostman髌骨骨折功能评分优良率、随访时X线检查和膝关节活动度,对带线锚钉技术治疗急性髌骨下极撕脱性骨折的临床疗效进行分析.结果 患者均获得随访,随访时间12～23个月,平均16.5个月.除1例患者出现锚线异物反应,经手术处理后创口顺利愈合;其余患者切口愈合良好.术后6个月随访摄X线片显示髌骨均骨性愈合.术后半年Bostman髌骨骨折功能评分（27.3±2.3）分,优28例,良5例,优良率100%.术后膝关节稳定,术后第3天活动度,伸4.2°±2.1°,屈79.5°±12.4°;术后1个月,伸2.7°±2.0°,屈107.8°±17.2°;术后6个月,伸-2.5°±2.1,屈122°±5.3°.股四头肌肌力5级,无膝前疼痛及其他并发症,功能明显改善.结论 带线锚钉技术治疗急性髌骨下极撕脱性骨折具有创伤小、固定可靠、术后患者能够早期进行功能锻炼,且不需二次手术的优点,其为髌骨下极撕脱性骨折患者治疗提供一种可靠的选择.

Objective To investigate the feasibility and clinical effects of suture anchors technique for acute distal avulsion fracture of patella. Methods From January 2007 to July 2009, 33 patients（18males and 15 females, ranging from 28 to 72 years, with an average of 49.3 years） were treated with the suture anchors technique. The average time from injury to surgery was 3.5 days（2 to 7 d）. Injury reason： traffic accident in 12 cases, injured in daily life in 11 cases, sports injury 9 cases, no clear trauma history in one case. The Bostman evaluation system, follow-up X-ray, and knee mobility were used to analyze the clinical effects of suture anchors technique. Results All patients obtained the follow-up and the average time was 16.5 months（12 to 23 months ）. One patient suffered foreign body reaction, and his wound healing was good after operation. The remaining patient wound healing was good. No complications were found in all patients,such as popliteal fossa artery, tibial nerves or peroneal nerve complication. Bostman patella fracture functional score 27.3±2.3 points at the sixth months follow up, 28 cases were rated as excellent, 5 cases were good, and the excellent and good rate was 100%. Six months later, X-ray showed bone healing, knee activity recovered well. The Range of Motion was extension for -2.5°±2.1° and flexion for 122°±5.3°. Conclusion Suture anchors fixation in treatment of acute distal avulsion fracture of patella has a good efficacy, safety and reliability advantages, and without the second operation. This technique provides an alternative in lower pole patella fracture.