高强度缝线内固定治疗髌骨横形骨折的疗效观察

Effectiveness of high strength suture fixation in treatment of patellar transverse fracture

目的探讨高强度缝线内固定治疗髌骨横形骨折的疗效。方法 2014年6月–2016年6月,采用高强度缝线内固定治疗38例髌骨横形骨折患者。男24例,女14例;年龄26～64岁,平均45岁。致伤原因:交通事故伤6例,摔伤32例。受伤至手术时间为2～8 d,平均5 d。术前疼痛视觉模拟评分(VAS)为(84.3±8.4)分,Lysholm评分为(44.5±7.2)分,膝关节活动度为(62±12)°。结果术后患者切口均Ⅰ期愈合,无神经血管损伤、下肢深静脉血栓形成、局部异物刺激反应等并发症发生。术后2 d X线片检查示,髌骨骨折均达满意复位与稳定固定。患者术后均获随访,随访时间12～18个月,平均16个月。骨折均愈合,愈合时间2～4个月,平均3个月。末次随访,参照B?stman评分标准评定:优36例、良2例,优良率达100%。VAS评分为(10.2±6.6)分、Lysholm评分为(93.1±6.4)分、膝关节活动度为(124±14)°,与术前比较差异均有统计学意义(t=42.759,P=0.000;t=31.099,P=0.000;t=20.727,P=0.000)。结论高强度缝线内固定治疗髌骨横形骨折具有操作简便、固定牢靠、并发症少、无需二次手术取出内固定物等优点,术后患者膝关节活动度和功能均恢复满意。

Objective To explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture. Methods Between June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years（mean, 45 years）. There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days（mean, 5 days）. The preoperative visual analogue scale（VAS） score, Lysholm score, and range of motion（ROM） of patients were 84.3±8.4, 44.5±7.2, and（62±12）°, respectively. Results All patients＇ incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months（mean, 16 months）. All fractures healed and the healing time was 2-4 months（mean, 3 months）. At last follow-up, according to the B？stman criteria,36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score,and ROM of patients were 10.2±6.6, 93.1±6.4, and（124±14）°, respectively, showing significant differences when compared with preoperative ones（t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000）. Conclusion Application of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.