髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折

Treatment of inferior polar fracture of patella with patellar claw combining tension band

目的探讨髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折的临床疗效。方法回顾分析中国人民解放军第184医院骨科2008年08月至2014年10月收治髌骨下极粉碎性骨折53例,排除髌骨体骨折病例。给予单纯克氏针张力带治疗(克氏针组)28例,克氏针张力带结合髌骨爪治疗(髌骨爪结合组)25例。记录克氏针组及髌骨爪组的愈合时间、术后并发症及其末次随访的膝关节功能比较,统计学方法采用SPSS 13.0统计软件进行数据分析,骨折愈合时间采用独立样本t检验,两组的术后并发症及其末次随访的膝关节功能采用2检验,结果 53例均获得随访,随访时间平均(12.5±2.9)个月,髌骨爪结合组愈合时间(9.7±0.9)周早于克氏针组愈合时间(10.3±0.9)周,组间的差异有统计学意义(t=2.393,P<0.05),根据美国纽约特种外科医院(HSS)评分标准进行评价,克氏针组优10例,良9例,可7例,差2例,优良率67.9%;髌骨爪结合组优13例,良10例,可1例,差1例,优良率92%;两组差异有显著性意义(2=4.681,P<0.05),克氏针组中1例术后出现创伤性关节炎。3例出现内固定松动,4例关节僵硬,髌骨爪结合组中1例术后创伤性关节炎,未出现内固定松动,两组并发症发生率差异有显著性意义(2=4.045,P<0.05)。结论采用髌骨爪结合克氏针张力带治疗髌骨下极粉碎性骨折可以早期膝关节功能锻炼,避免关节僵硬,疗效满意。

Objective To report the clinical results of the treatment of inferior polar fracture of the patella with patellar claw combined with tension band. Methods From August 2008 to October 2014,53 cases of inferior polar fracture of the patella treated in the department of orthopedics,the 184 th Hospital of PLA were enrolled in the study,and cases of fracture at patellar body were excluded. The treatment of 28 cases used only tension band（the Kirschner wire group）; the treatment of the other 25 cases used patellar claw combining with tension band（the patellar claw group）. The comparison of the healing time postoperative complications and the function of knee joint in the last follow-up between the Kirschner wire group and the patellar claw group was carried out. Statistical analysis was performed using SPSS 13. 0 software for data analysis,which applied independent sample t test for fracture healing time,the postoperative complications,and chi-square test for the knee joint function. Results All the cases were followed up for（12. 5 ± 2. 9）months on average. The healing time of the patellar claw group [（9. 7 ± 0. 9） weeks]was shorter than that of the kirschner wire group [（10. 3 ± 0. 9） weeks ]; the difference was significant（t = 2. 393,P 〈 0. 05）.According to the Hospital of Special Surgery（HSS） scores,in the kirschner wire group,10 patients recovered with excellent effect,nine patients with fine effect,seven patients with ordinary effect,and two patients obtained poor results; the fine rate was 67. 9%. In the patellar claw group,13 patients recovered with excellent effect,10 patients with fine effect,one patients with ordinary effect,and one patients obtained poor results; the fine rate was 92%. The difference was significant（2= 4. 681,P 〈 0. 05）. In the Kirschner wire group,one case had traumatic arthritis,three cases occurred the internal fixation loosening,four cases occurred joint stiffness; in the patellar claw group,one case had traumatic arthritis,no internal fixation loosening was observed; the difference was significant（2= 4. 045,P 〈 0. 05）. Conclusion The treatment of inferior polar fracture using the patellar claw combining tension band can achieve early knee joint function exercise and avoid joint stiffness,with satisfactory curative effect.