关节镜下经皮空心螺钉联合钢丝环扎固定治疗非粉碎性髌骨骨折的疗效

Arthroscopic-Assisted Percutaneous Cannulated Screw and Cerclage Wire Fixation for Noncomminuted Patellar Fractures

目的探讨关节镜下经皮空心螺钉联合钢丝环扎固定治疗非粉碎性髌骨骨折的手术方法及临床疗效。方法将42例非粉碎性髌骨骨折患者根据手术固定方法的不同分为关节镜治疗组(22例)和传统切开复位组(20例)。关节镜治疗组采用关节镜下经皮空心螺钉联合钢丝环扎固定;传统切开复位组采用传统的切开复位空心螺钉张力带固定。对2组患者手术切口直径、术后骨折愈合时间、并发症(感染、活动受限、行走时疼痛)发生率及膝关节功能恢复情况等进行比较。结果 2组患者术后均获得平均20个月的随访。关节镜治疗组的手术切口直径、术后骨折愈合时间及并发症发生率分别为(6.4±1.4)cm、(9.7±1.2)周及0.0%,传统切开复位组的手术切口、术后骨折愈合时间及并发症发生率分别为(8.3±1.3)cm、(12.1±1.7)周及25.0%,2组比较差异均有统计学意义(均P<0.05)。膝关节功能按Lysholm评分:关节镜治疗组的膝关节功能评分为(85.3±3.4)分,传统切开复位组的膝关节功能评分为(83.0±4.6)分,2组比较差异无统计学意义(P>0.05)。2组患者X线片复查均未见明显关节面不平,未见延迟愈合及不愈合。结论关节镜下经皮空心螺钉联合钢丝环扎固定可在直视下行骨折复位,术中可行关节腔冲洗,同时修补其他损伤组织,手术创伤小、并发症少,是治疗髌骨骨折的有效方法之一。

Objective To explore the surgical method of noncomminuted patellar fractures and the clinical efficacy of arthroscopic-assisted percutaneous cannulated screw and cerclage wire fixation. Methods Forty-two patients with noncomminuted patellar fractures were divided into two groups. Arthroscopic treatment group （n=22） received arthroscopic-assisted percutaneous cannulated screw and cerclage wire fixation. Traditional open reduction group （n=20） received open reduction and cannulated screw tension band fixation. Incision size,fracture healing t/me,complications （infection,activity limitation, and pain on walking） and functional recovery of knee joint were compared between the two groups. Results Patients were followed-up for an average of 20 months. Incision size, time to fracture healing and incidence of complications were, respectively, （6.4±1.4）cm, （9.7±1.2）weeks and 0.0% in arthroscopic treatment group,and （8.3±1.3） cm, （12.1±1.7）weeks and 25.0% in traditional open redu- ction group. The differences were statistically significant between the two groups （P〈0.05）. Lysholm score in arthroscopic treatment group （85.3±3.4） was not significantly different from that in traditional open reduction group（83.0±4.6）（P〉0.05）. No obvious rough articular surface, delayed union and nonu- nion were observed by X-ray examination. Conclusion Arthroscopic-assisted percutaneous cannulated screw and cerclage wire fixation is effective for patellar fractures with advantages of minimal invasionand few complications. Furthermore, joint cavity flushing and injured tissue repair can be performed during fracture reduction.