空心拉力螺钉加金属线缆治疗髌骨骨折

Clinical analysis of hollow pull screw plus mental cable in the treatment of patellar fracture

目的:探讨应用空心拉力螺钉加金属线缆内固定治疗髌骨大块骨折的临床疗效及生物力学特性。方法:收集2012年1月至2016年1月温州市中心医院收治的53例闭合髌骨大块骨折的患者,随机分为观察组和对照组。观察组26例实施切开复位空心拉力螺钉加金属线缆内固定术;对照组27例实施切开复位AO克氏针钢丝张力带内固定术。对2组患者手术时间、骨性愈合时间、膝关节功能、并发症进行比较,对2组实体实验生物力学固定牢固程度进行比较。结果:2组手术时间和骨性愈合时间比较差异无统计学意义(P>0.05)。比较2组膝关节功能评分,观察组优良率100%,对照组优良率96.3%,差异无统计学意义(P> 0.05)。观察组并发症发生率为0,对照组并发症发生率为25.9%,2组差异有统计学意义(P<0.05)。在生物力学方面,2组髌骨骨折断端裂隙在移位1 mm距离下实体实验观察组髌骨作用力大于实体实验对照组,差异有统计学意义(P<0.05)。结论:空心拉力螺钉加金属线缆内固定和AO克氏针钢丝张力带内固定治疗髌骨大块骨折都能取得良好的临床疗效,前者较后者具有综合疗效好、并发症少、生物力学固定强度高的优点。

Objective： To study the clinical effects of hollow tension screw plus metal cable on large patellar fracture and explore biomechanical features. Methods： From January 2012 to January 2016, a total of 53 patients admitted to Wenzhou Central Hospital for closed patellar fracture were divided into the observation group and the control group. In the observation group, 26 cases were performed with open reduction hollow tension screw and metal wire internal fixation. In the control group, 27 cases were treated by open reduction and reduction of AO Kirschner wire tension band internal fixation. The two groups of patients were compared in terms of operation time, bone healing time, knee joint function and complications as well as biomechanical fixation firmness. Results： There was no statistical difference between the two groups in operation time and bone healing time（P〉0.05）. In comparison of knee joint scoring, the optimal rate was 100% in the observation group and 96.3% in the control group, with no statistical difference（P〉0.05）. The incidence rate of complications was 0% in the observation group and 25.9% in the control group, showing significant difference（P〈0.05）. In the aspect of biomechanics, patellar forces in the observation group was greater than the control group in the entity experiment of patella fracture end fracture under the shift distance of 1 mm, showing statistical difference between the two groups（P〈0.05）. Conclusion： Both hollow pulling screw plus metal wire internal fixation and AO steel wire tension band internal fixation have good healing effect in the clinical treatment of patella large fractures, however, the former has the advantages of better overall curative effect, fewer complications and stronger biomechanics fixation.