外支架固定治疗31例髌骨移位骨折的疗效观察

Observation of curative effect on 31 cases of displaced patellar fracture treated with external fixation

[目的]探讨外支架固定治疗髌骨移位骨折的临床疗效。[方法]对31例髌骨移位骨折采用外支架固定,其中新鲜骨折28例,陈旧骨折3例;横形骨折17例,斜形骨折3例,粉碎性骨折11例;其中半月板Ⅲ度损伤2例,前交叉韧带损伤1例。采用经皮手法推压及克氏针撬拔复位外支架固定26例,其中应用膝关节镜监护8例;切开复位外支架固定5例。入院距手术时间2 h～9 d,平均4 d。[结果]本组31例中有5例采用切开复位外支架固定,术后无切口感染及深部感染,切口均一期愈合。全部31例患者获得随访,随访时间6～29个月,平均16个月。骨折于4～6个月全部愈合。2例(6.5%)发生针道感染,经局部换药及口服抗生素治疗,针道感染控制。1例因术后护理及功能训练不当,导致膝关节功能部分障碍,其余膝关节功能恢复良好,无外支架松脱及断裂。优良率达96.8%。[结论]外支架固定技术是微创技术,具有手术创伤较轻,对局部干扰较小,技术操作简单省时,弹性固定可靠,有生理加压性能,术后并发症较少,骨折愈合率较高,有利于术后早期功能训练,尽快恢复膝关节的功能,也不需再次取内固定等优点。外支架固定治疗髌骨骨折完全满足了骨折的解剖复位及有效固定的要求,临床使用价值较高。

[ Objective] To investigate the clinical effects of external fixation in treatment of displaced patellar fracture. [ Method] All 31 cases were performed external fixation. Of these cases,28 were fresh fracture,3 were old; 17 were transverse fracture, 11 were comminuted and 3 were oblique,2 supervened with meniscus injury （ third degree） and 1 with anterior cruciate ligament（ACL） injury. Twenty-six cases were treated with percutaneous reduction by leverage and external fixation, 8 were as-sisted by arthroscopy,5 were treated by open reduction and external fixation. All cases underwent surgery in 2 hours-9 days after admission （averaging g days）. [ Result] All cases were followed up for 6-29 months （averaging 16 months）, and all healed in 4 - 6 months. All of the cases treated by open reduction and external fixation were primary healing without any infection. Two ca-ses had needle infection （6.5%） and healed after positive dressing and oral antibiotics. All the recovery of knee-joint function was satisfactory,except 1 case had partial dysfunction because of improper postoperative care and functional training. There was no loosening or breaking. The excellent and good results rate was 96.8%. [ Conclusion] The external fixation is minimally inva- sire, easy to operate and time saving, providing elastic fixation and continuous compression, with less complications and high rate of union, permits early exercise, and can get the greatest recovery of the knee-joint function. There is no need for a second opera- tion of internal fixator removal. Using external fixation to treat the displaced patellar fracture easily lead to anatomical reduction and rigid fixation.