张力带涤纶线内固定治疗髌骨骨折的临床研究

Patella fracture:treatment with polyester tension bend and postoperatine rehabilitation

目的 :为避免应用金属内固定方法治疗髌骨骨折的并发症 ,我们利用张力带内固定原理 ,设计一种新的手术方法并结合康复治疗。方法 :生物力学研究发现 ,本法固定强度达到能承受 1— 2倍人体体重。临床应用 31例 ,术中固定完成后屈膝 90°。骨折无移位。术后 4周内不负重在屈膝 90°范围进行膝关节ROM及肌力训练 ,4周后加大ROM及肌力训练强度 ,并逐步下地负重训练。结果 :随访 6— 48个月 ,骨折愈合时间 6— 12周。按胥氏评分 :膝关节功能优 2 2例 ,良 9例 ;膝关节活动范围优 2 3例 ,良 8例 ;骨折复位优 2 2例 ,良 9例。肌肉无明显萎缩 ,肌力全部恢复正常。结论 :该方法固定牢靠 ,并发症少 ,不需要二次手术。术后康复可以促进骨痂生长及软骨面的修复 ,防止肌肉萎缩、关节粘连及骨质疏松、骨折病等。

Objective: To avoid the complications of the Arbeitsgemeinschaft fur Osteosynthesefrage(AO) tension bend for the treatment of patella fracture, the polyester tension bend was used following rehabilitation. Method: Biomechanical test indicated that this technique could stand two times body weight. Thirty-one cases were treated by this technique. The segments maintained stable while flexed the knee within 90° after it fixed. ROM and strength training started at the operation day but the flexion should be within 90°. The exercise could be increase post the union of the fracture and weight bearing progressively.Result:The following-up last 6-48 months. The union time was 6-12 weeks. According the Qi′s score, 22 cases were excellent and 9 cases were good in the knee function and fracture fixation, 23 cases were excellent and 8 cases were good in ROM of the knee. There were no muscles atrophy and the strength recovered normally. Conclusion: Polyester tension bend provides good stability in fixation with less complication and do not need re-operation. Post-surgery rehabilitation promotes the union of the fracture and renovates of the cartilage surface.