三角形捆绑法在髌骨骨折手术中应用的临床研究

Clinical study on application of triangular binding method in operation of patella fracture

目的:研究三角形捆绑法在髌骨骨折手术中应用的临床效果与意义。方法:选择我院骨科收治的髌骨骨折患者120例作为研究对象,随机分为观察组与对照组,各60例。观察组患者术中应用三角形捆绑法进行复位及临时内固定;对照组采用撬拨复位、翻转复位、环形捆绑复位等带用复位方法进行复位。所有病例使用克氏针张力带作为最终内固定。对比2组患者术中是否需要打开股四头肌扩张部、2次复位情况、使用X光机次数、是否需要额外增加金属固定物、手术时间、术后患膝关节Bostman评分。结果:所有病例切口均I期愈合,未见下肢深静脉血栓形成。复查X线片提示术后未见再骨折及骨折移位,内固定物取出前未发生克氏针移位,骨折愈合良好。6-8周左右骨折线基本消失,平均6.5周。术后12个月将固定物取出,再未发生骨折。观察组打开股四头肌扩张部例数、需2次复位例数、使用X光机次数、手术时间显著少于对照组(P<0.05),观察组术中未再添加额外金属骨针进行固定(P<0.05),术后膝关节Bostman评分2组无差异(P>0.05)。结论:三角形捆绑法具有操作简便、复位可靠、缩短手术时间的优势,能够减少软组织2次损伤、减少X线接触及使用额外的金属内固定物,对骨折块起到有效复位和初步固定的作用,有助于患膝关节功能恢复,值得在临床中推广应用。

Objective: To study the clinical effect and significance of triangular binding method in the operation of patella fractures. Methods: 120 patients with patellar fractures treated in our hospital were randomly divided into observation group and control group, each of 60 cases. In the observation group, the triangular bundle method was used for the reduction and temporary internal fixation, and the control group was reset by using the common reset methods such as pry reset, reverse reset and ring bundle reset. All cases were treated with a kirschner wire tension band as a final internal fixation. The two groups of patients were required to open the femoral four muscle expansion ,two reset, the number of X - ray machines, the need for additional metal fixation, surgery time, postoperative knee Bostman score. Results: all cases of incision were healed in phase I, and no deep vein thrombosis was seen in the lower extremities. After X - ray examination, it was found that no re - fractures and fractures were displaced, no kirschner needle was removed before the internal fixation, and the fracture healed well. 6-8 weeks or so the fracture line basically disappeared, on average 6. 5 weeks. The fixation was removed 12 months after the operation, and no fracture occurred. Observation Group Open four head muscle expansion of the number of cases, two times the number of reduction cases, the number of X - ray machine, surgery time significantly less than the control group ( P05 ), the observation group did not add additional metal spicule for Fixation ( P05 ), postoperative knee Bostman score two groups no difference ( p > 0. 05). Conclusion: the triangular bundle method had the advantages of simple operation, reliable resetting and shortening of operation time, which could reduce two damage of soft tissue, reduce X - ray contact and use additional metal internal fixation, and play a role of effective reduction and initial fixation for fracture block, which was worthy to be popularized in clinic.