钢丝环扎加Maxon线张力带缝合治疗髌骨骨折的实验研究

Experimental study of circular wire and maxon tension band wire suture treated fracture of patella

目的：进一步改进骸骨骨折，特别是粉碎性骨折的治疗方法。方法：取４具湿润尸体完整膝关节，保留一定的股骨胫骨长度，除股四头肌，关节囊，髌腱外去除其它软组织，伸直位固定股四头肌，制作髌骨横断骨拆模型，采用４×４拉丁方设计，分别按序作四种不同固定Ａ、钢丝环扎加Ｍａｘｏｎ线张力带缝合；Ｂ、改良张力带固定； Ｃ、张力带钢丝固定；Ｄ、单纯钢丝环扎。用胥少汀法作生物力学测定。结果：四种固定方法固定效果有显著性差异（Ｐ＜０．０５），Ａ与 Ｂ效果接近，为最好，Ｃ较差，Ｄ最差。股四头肌拉力在钢丝环扎加Ｍａｘｏｎ张力带缝合和改良张力带固定，均可达体重２倍以上。结论：对某些骸骨粉碎骨折，不适合改良张力带固定，则钢丝环扎加Ｍａｘ ｏｎ线张力带缝合效果最佳，该方法可满足早期功能锻炼，尽早恢复膝关节功能。

Objective To improve the treatment of fracture of patella, especially in the treatment of comnminut- ed fracture. Methods : Using four cadaver wet knee specimens witn certain length of femur and tibia preserved, except the quadriceps muscle, the capsule, the patella tendon, the other soft tissues were removed. The quadriceps muscle fixated under the knee was completely extended. The model of patella transverse fracture was made. Using 4 × 4 Latin Square design,four fixation methods were used: A. circular wire and Maxon tension band wire suture; B. modified tension band wire; C. tension band wire and D. only circular wire. Measurement of biomechanics of every model was wade with XU Shao - ting' s method. Results : The efficiency of four fixations had significant difference (P<0. 05). The A is similar to B. Both are better than the other two. D is the worst. The extension force of quadriceps tendon of the circular wire and Maxon tension band wire suture and the modified tension band wire reached two times of body weight. Conclusion : For some comminuted fracture, the modified tension band wire is not suitable ,then, the circular wire and Maxon tension band wire suture are the best. The method is reliable and responsible to early function exercise.