直切口与横S形切口治疗髌骨骨折对术后瘢痕形成及关节功能的影响比较

Comparison of the Effects of Straight and Transverse S Incision on the Postoperative Scar Formation and Joint Function of patients with Patellar Fracture

目的:观察和比较直切口与横S形切口治疗髌骨骨折对术后瘢痕形成及关节功能的影响。方法:回顾性分析2014年3月~2016年9月85例髌骨骨折患者的临床资料,包括采取手术直切口40例与采取手术横S形切口45例,比较两组的切口长度、手术时间、术后并发症以及随访时的瘢痕形成比例和Bostman关节功能评分。结果:两组的手术时间、术后切口感染及切口皮肤坏死发生率比较差异均无统计学意义(P>0.05),但横S形切口组的切口长度为127.79±5.55,明显长于直切口组的72.64±6.75(P<0.05);横S形切口组的术后局部麻木发生率为24.4%,明显高于直切口组的7.5%(P<0.05);术后随访12周时,横S形切口组的Bostman评分为20.63±5.73,明显低于直切口组的26.83±4.76(P<0.05);随访24周时,两组的Bostman评分比较差异无明显统计学意义(P>0.05)。横S形切口组的瘢痕形成发生率为33.3%,明显高于直切口组的17.5%(P<0.05)。结论:直切口用于治疗髌骨骨折的创伤明显小于横S形切口,术后瘢痕形成更少,关节功能恢复更快,但横S形切口的显露更好,在临床实际中应根据髌骨骨折患者的具体情况合理抉择手术切口方式。

Objective： To compare the effects of straight and transverse S incision on the postoperative scar formation and joint function of patients with patellar fracture. Methods： The clinical data of 85 cases of patients with patellar fracture from March 2014 to September 2016 were retrospectively analyzed, 40 cases were treated with surgical straight incision and 45 cases were treated with S transverse incision. The incision length, operation time, incidence of postoperative complications, the ratio of scar formation and Bostman joint function score were compared between the two groups. Results： There was no significant difference in the operation time,incision infection and incision skin necrosis between two groups（P〉0.05）. However, the incision length of transverse S incision group（127.79±5.55） was significantly longer than that of the straight incision group（72.64±6.75, P〈0.05）, and the incidence of postoperative numbness in transverse S incision group（24.4%） was significantly higher than that in the straight incision group（7.5%, P〈0.05）. After follow-up for 12 weeks, the Bostman score of transverse S incision group（20.63±5.73） was significantly lower than that of the straight incision group（26.83 ±4.76, P〉0.05）, and after follow-up for 24 weeks, the Bostman scores between the two groups showed no significantly difference（P〉0.05）. The incidence of scar formation in transverse S incision group（33.3%） was significantly higher than that of the straight incision group（17.5%, P〈0.05）. Conclusions： The trauma of straight incision was significantly smaller than that of the transverse S shaped incision, so the scar formation was less and the joint function recovered faster. However, the transverse S shape incision was better, and in clinical practiceshould according to the specific situation of the patients with patellar fracture to choose the surgical incision.