非克氏针改良钢丝张力带内固定治疗髌骨骨折

Treatment for patellar fracture using internal fixation with non-Kirschner modified wire tension band

目的:观察非克氏针改良钢丝张力带内固定治疗髌骨骨折的临床疗效。方法:髌骨骨折手术患者52例,K组即传统克氏针钢丝张力带内固定24例;NK组即非克氏针钢丝张力带内固定28例。比较两组患者住院费用、手术时间、术中失血量、骨折愈合时间,并对术后内固定松动、断裂、针端触及疼痛不适感等常见并发症以及术后2周、1、3、6、12月时膝关节Bostman功能评价进行比较。结果:K组术后常见并发症内固定松动4例(17.4%),断裂1例(4.3%),针端触及疼痛不适6例(26.1%)。NK组患者没有出现上述常见并发症,两组比较差异有统计学意义(P<0.05)。按照膝关节Bostman功能评价K组优11例,良8例,差4例,优良率82.6%;NK组优18例,良7例,差1例,优良率96.2%。除两周外其余各观察时点两组比较差异有统计学意义(P<0.05)。随访显示K组要求取出内固定的患者18例(78.3%),而NK组为8例(30.8%),两组比较差异有统计学意义(P<0.05)。结论 :与传统的克氏针钢丝张力带内固定相比,非克氏针改良钢丝张力带内固定不增加医疗费用、手术时间术中失血量和骨折愈合时间,具有并发症少、关节功能恢复良好等优点。

Objective： To observe the clinical effect of using internal fixation with non-Kirschner modified wire tension band on patellar fracture. Methods： 52 cases of patellar fracture were operated according to the standard protocol designed for the study. Of the 52 cases, 24 were underwent internal fixation with traditional Kirschner wire tension band group（K group）and 28 were with non-Kirschner modified wire tension band group（NK group）. The cost of hospitalization, operating time, loss of blood intraoperative and time of fracture healing,complications of loosening and breakage of internal fixation, and the pain on touching Kirschner wire and the functional evaluation using Bostman method at 2 weeks, and 1, 3, 6 and 12 months postoperation were compared.Results： In the K group, 4 cases showed loosening of internal fixation（17.4%）, 1 breakage of internal fixation（4.3%） and 6 showed pain on touching Kirschner wire（26.1%）, but none in the NK group showed any complications observed in the K group, and the differences were significant between the twos（P 〈 0.05）. The cases showed excellent, good and poor were 11, 8 and 4 respectively and the rate of fineness was 82.6% based on Bostman evaluation in K group. However, the corresponding figures in the NK group were 18, 7, and 1, and96.2%. Except at 2 weeks, all differences were statistically significant in the twos（P 〈 0.05）. Eighteen cases（78.3%）asked to have their internal fixation devices removed in K group while 8 cases（30.8%） in NK group,which was statistically different（P 〈 0.05）. Conclusion： Comparing with the internal fixation with traditional Kirschner wire tension band, non-Kirschner modified wire tension band showed no increased medical cost,operating time, intraoperative blood loss and the time of fracture healing. Furthermore it showed, less complications,faster and better rehabilitation of joint functions.