老年髌骨移位性骨折的手术治疗

Operative treatment of displaced fracture of patella in the elderly

目的 评价髌骨张力带内固定术、部分切除术及改良式部分髌骨切除术治疗老年移位性髌骨骨折的疗效。方法 41例老年移位性髌骨骨折 ,其中 2 2例髌骨中部横断或粉碎性骨折 ,采用张力带内固定术 ;5例髌骨下极骨折采用髌骨部分切除术 ;11例髌骨下极骨折和 3例上极骨折采用改良式部分髌骨切除术。结果 术后随访 2～ 7年 ,按陆裕朴评定标准 ,张力带内固定术 :优 18例 ,良 2例 ,可 2例 ;部分切除术 :可 3例 ,差 2例 ;改良式部分髌骨切除术 :优 13例 ,良 1例。结论 张力带内固定术与改良式部分髌骨切除术是治疗老年移位性髌骨骨折的有效方法 ,治疗关键是解剖复位、稳妥固定及早期非负重功能锻炼。

Objective To investigate the clinical effects of tension band internal fixation of patella,partial patellectomy and modified partial patellectomy on displaced fracture of patella in the elderly.[WT5”HZ]Methods[WT5”BZ] Of 41 old patients with displaced fracture of the patella,22 with transverse or comminuted fracture at the middle part of patella were treated with tension band internal fixation;5 of inferior polar fracture of patella were treated with partial patellectomy and the other 11 with inferior polar fracture of patella and 3 with superion polar fracture of patella were treated with modified partial patellectomy.[WT5”HZ]Results[WT5”BZ] The follow up period ranged from 2 to 7 years.According to Lu’s evaluation standards,there were 18 excellent cases,2 good and 2 fair in tension band internal fixation group;3 fair and 2 poor in partial patellectomy group;13 excellent and 1 good in modified partial patellectomy.[WT5”HZ]Conclusion[WT5”BZ] The tesion band internal fixation and the modified partial patellectomy are the effective methods to treat the displaced fracture of the patelle in the elderly.The key points of success are anatomic reduction,stable fixation and early functional exercises under non weight bearing conditions.