自体骨膜游离移植一期修复髌骨骨折及软骨缺损

PRIMARY REPAIR OF CARTIL AGE DEFECT ACCOMPANYING PATEL L AR FRACTURE WITH FREE AU- TO- PERIOSTEAL GRAFT

目的 探讨自体骨膜游离移植一期修复严重粉碎性髌骨骨折软骨缺损的临床疗效。方法 1992年 1月～ 1998年 8月 ,用自体骨膜游离移植一期修复严重粉碎性髌骨骨折软骨缺损 17例 ,其中全髌骨粉碎骨折 9例 ,髌骨中上极骨折 3例 ,髌骨中下极骨折 5例。采用膝内侧 S形切口经膝关节腔入路。骨折复位后钢丝内固定 ,清除骨折区残存软骨 ,露出松质骨 ,修理平整 ;胫骨上端前内侧切取骨膜 3cm× 4cm～ 5 cm× 6 cm,游离移植到软骨缺损区并固定 ,术后 1周开始关节被动活动。结果 17例全部获得随访 ,时间为 8个月～ 6年 2个月 ,平均为 2 .8年。优 12例 ,膝关节功能正常 ;良 4例 ,膝关节功能基本正常 ;可 1例 ,膝关节活动受限 ,但屈曲大于 90°。结论 自体骨膜游离移植一期修复髌骨骨折软骨缺损 ,取材容易 ,操作简便 ,疗效满意 ,有临床应用价值。

Objective To evaluate the results of free auto- periosteal graft in prim ary repair of cartilage defect accom panying severe com minuted fracture of patella.Methods From January1992 to August1998,seven- teen cases with extensive cartilage defect due to severe comminuted fracture of patella were primarily repaired with free auto- periosteal graft.In these cases,there were whole patellar fracture in9patients,upper two third patellar fracture in3patients and lower two third patellar fracture in5 patients.During operation,' S' - shaped incision a- long m edial side of knee through intra- cavity pathway were used.After fixation of the patellar fracture and clear- ance of the residual cartilage in the fracture area,the cancellous bone was exposed and trim med.The free perios- teum was incised from the anterior m edial side of upper tibia and then transplanted to the region of cartilage defect. The size of grafted periosteum ranged from3cm× 4cm to5 cm× 6 cm.The knee joint was received passive m otion at7days after operation.Results All cases were followed up8to74m onths.There were excellentrecovery in12 patients and the function of knee joint was norm al,better recovery in4patients and the function of knee jointwas nearly normal,and m oderate recovery in1patient and the function of knee jointwas lim ited mildly.Conclusion Free auto- periosteal graft is a sim ple and effective treatment in prim ary repair of cartilage defect accompanying patellar fracture.It is valuable to apply in clinical practice.