张力带钢丝加多针环形钢丝内固定治疗髌骨粉碎性骨折

The application of internal fixation with tension band,multiple K-wire and annular steel-wire for the treatment of comminuted fractures of the patella

目的分析探讨髌骨粉碎性骨折的手术治疗方法及临床效果。方法回顾性分析2007年2月至2012年3月我科治疗髌骨粉碎性骨折18例，其中男13例，女5例；年龄20～61岁，平均41岁；按照王鹏建等的髌骨骨折分型方法，其中ⅢA型11例，ⅢB型6例，ⅢC型1例。所有病例均采用切开复位张力带钢丝加多针环形钢丝内固定手术方式治疗。术后每月门诊复查x线片并指导康复锻炼。通过对手术时间、髌骨关节面平整度、术后开始活动时间、术后随访有无复位丢失、切口愈合时间、骨折愈合时间及膝关节功能等指标的观察评定治疗效果。结果本组18例患者均获得随访，随访时间6～24个月，平均16个月。手术时间为100～150min，平均120min。术中透视及术后x线片显示髌骨关节面平整度满意。术后3天均开始逐步功能锻炼，术后12～14天拆线，无切口感染和愈合不良。术后随访x线片均无复位丢失，所有骨折均骨性愈合，骨愈合时间6～11周，平均9周。按陆裕朴膝关节功能评定标准评定：优10例、良6例、可2例，优良率为88．9％。结论张力带钢丝能维持坚强牢固固定以利于术后早期活动，多针使环形钢丝和张力带钢丝有所依托，环形钢丝保证了良好复位和防止复位丢失。张力带钢丝加多针环形钢丝固定治疗髌骨粉碎性骨折操作简单、固定可靠、可早期功能锻炼、效果确切，为治疗髌骨粉碎性骨折的有效方法。

Objective To analyze and explore the surgical treatment methods and clinical outcomes of comminuted fractures of the patella. Methods The data of 18 patients with cotmninuted fractures of the patella who were treated in our department from February 2007 to March 2012 were retrospectively analyzed. Among them, there were 13 males and 5 females, whose average age was 41 years old （ range; 20-61 years ）. According to the classification of comminuted fractures of the patella made by Pengjian Wang and so on, 11 patients were at III A, 6 patients at III B and 1 patient at III C. All patients underwent open reduction and internal fixation with tension band, multiple K-wire and annular steel-wire. The X-rays of the patients were reviewed in the clinic monthly after the operation, and rehabilitation exercises were introduced to them. The treatment outcomes were measured by the operation time, flatness of the patellar articular surfaces, start time after the operation, loss of reduction during the follow-up postoperatively, surgical incision healing time, bone fracture healing time, function of the knee joints and so on. Results All the 18 patients were followed up for an average period of 16 months （ range; 6-24 months ）. The average operation time was 120 min （ range; 100-150 min ）. The intraoperative fluoroscopy and postoperative X-rays showed the flatness of the patellar articular surfaces was satisfactory. Gradual functional exercises were started 3 days postoperatively. Sutures were removed 12-14 days postoperatively, with no surgical site infection or poor healing. The X-rays showed no loss of reduction during the follow-up postoperatively. Bone healing of the fractures was obtained in all the 18 patients after an average period of 9 weeks （ range; 6-11 weeks ）. According to Yupu Lu＇s standard of knee joint function evaluation, there were 10 excellent cases, 6 good and 2 fair, and the excellence and good rate was 88.9%. Conclusions Tension band can maintain the stabilization of the fractures, so as to improve the early postoperative activities. MultipleK-wire can prop annular steeD-wire and tension band up. Annular steel-wire can ensure good reduction and prevent its loss. Internal fixation with tension band, multiple K-wire and annular steel-wire is an effective treatment method for comminuted fractures of the patella, with the advantages of simple operation, reliable fixation, early functional exercises and exact effects.