髌骨骨折不同治疗方法的临床疗效比较

Comparative study of clinical effects of different treatments on patellar fracture

目的探究髌骨骨折不同治疗方法的临床疗效,为今后的临床工作提供参考依据。方法选择2011年1月至2012年6月来我院就诊的105例髌骨骨折患者为研究对象。根据手术治疗方法不同分为三组,其中行TiNi记忆合金髌股爪治疗33例(A组),改良AO张力带内固定术37例(B组),钢丝环扎治疗35例(C组)。观察各组的手术情况、三个月膝关节屈伸活动范围及6个月膝关节总体情况。结果 A组的手术时间明显短于改良B组、C组,经比较差异具有统计学意义(t=15.711,16.198,P<0.05)。A组的骨折愈合时间也明显短于B组、C组差异具有统计学意义(t=9.262,8.376,P<0.05)。A组的骨折复位优良率明显高于B组、C组差异具有统计学意义(χ2=4.353,4.725,P=0.037,0.030)。改良B组的手术时间、骨折愈合时间、骨折复位优良率与C组比较,差异无统计学意义(P>0.05)。A组三个月膝关节屈伸活动范围与B组、C组比较差异具有统计学意义(χ=28.537,7.988,P=0.036,0.046),而B组与C组比较差异无统计学意义(χ2=0.056,P=0.997)。A组6个月膝关节总体情况与B组、C组比较差异具有统计学意义(χ2=8.362,8.465,P=0.039,0.037),而B组与C组比较差异无统计学意义(χ2=0.312,P=0.958)。结论对髌骨骨折患者予以TiNi记忆合金髌骨爪固定,具有骨折愈合时间短、固定确实、手术方法易掌握及促进伤膝功能的早期康复等优势,是一种较理想的临床髌骨骨折内固定的新方法。

Objective To explore clinical effects of different treatments on patellar fracture and provide a reference for further clinical work. Methods One hundred and five patients with patellar fracture patients treated in our hospital from January 2011 to June 2012 were selected and divided into three groups according to operative treatment methods, including group A treated by TiNi memory alloy patellar claw with 33 patients, group B treated by modified AO tension band fixation with 37 patients, and group C treated by steel wire cerclage with 35 cases. The operative condition, knee flexion range within three months and overall condition of knee joint were observed. Results The operation time in group A was significantly shorter that in group B and group C （r= 15.711, 16.198, P 〈 0.05）. The fracture healing time in group A was significantly shorter than that in group B and group C （t= 9.262, 8.376, P〈 0.05）. And the excellent and good rate of fracture reduction in group A was significantly higher than that in group B and group C. However, there was no difference in the operation time, fracture healing time, excellent and good rate of fracture reduction between group B and group C. The knee flexion range within three months and overall condition of knee joint within 6 months in group A were statistically different from those in group B and group C （）~z=-8.537, 7.988, P=0.036, 0.046）, while there were no differences between group B and group C. Conclusion The TiNi memory alloy patellar claw fixation for patients with patellar fracture showed advantages of shorter fracture healing time, secure fixation, being easy to be manipulated and facilitation of early recovery of injured knee function, and it is an ideal new internal fixation method for clinical patellar fracture.