拉出钢丝技术治疗髌骨分层骨折6例报告

Effect analysis of pull-out wire on patellar layered fracture

目的探讨利用拉出钢丝治疗髌骨分层骨折的临床疗效。方法回顾性分析中国人民解放军第971医院骨二科收治髌骨骨折患者的临床资料,本研究纳入标准包括年龄不超过60岁、闭合性骨折、CT检查证实髌骨分层样移位以及术后随访时间超过2年;排除合并损伤神经血管及韧带的患者,共纳入髌骨分层骨折患者6例,其中拉出钢丝联合克氏针张力带治疗5例,联合空心螺钉治疗1例;男4例,女2例,平均年龄(40.0±2.0)岁;骨折类型依据Rookwood[1]分型,Ⅳ型2例,Ⅴ型4例,远端分层骨折6例,骨折均为粉碎性。末次随访依据胥少汀等制定的疗效标准评估疗效。结果6例患者均获随访,随访时间22~28个月,平均(24.0±1.5)个月。术后2月随访时骨折均达到临床愈合,无感染、内固定物断裂发生。随访期间2例出现膝关节屈伸活动时偶痛,1例出现内固定物激惹,内固定取出后症状缓解。末次随访X线检查发现髌骨异位骨化1例,所有患者均无明显关节退变征象。依据胥少汀等制定评分标准,优4例,良2例。结论髌骨分层骨折临床上比较少见,且易漏诊,拉出钢丝技术简便易行,同时联合克氏针张力带等技术疗效可观,对于此类复杂性骨折可以临床应用。

Objective To investigate the clinical effect of pull-out wire in the treatment of patellar layered fracture.Methods Retrospective analysis was performed on the clinical data of patients with patellar fracture admitted to No.971 Hospital of the People’s Liberation Army(PLA).The inclusion criteria included age less than 60 years,closed fracture,layered displacement of patellar fracture confirmed by CT examination,and postoperative follow-up over two years.The patients with complicated neurovascular and ligament injury were excluded,and a total of six patients with patella layered fractures were enrolled in this study(five patients treated with pull-out wire and K-wire tension band fixation;one patient treated with pull-out wire and cannulated screw).There were four males and two females with a mean age of(40.0±2.0)years.Two cases of type IV fracture and four type V fractures were classified according to Rookwood classification.Evaluation of the efficacy according to the score standard of Xu Shaoting.Results All the patients were followed up for(24.0±1.5)months.Clinical healing in all the patients were achieved at two months.Infection and implant breakage did not occurred during follow-up.Two cases had occasional pain during knee activity;one case had irritation,and then relieved after withdrawal of the internal fixation.Radiograph showed that one case had heterotopic ossification but no post-traumatic arthritis occurred in all patients at the last follow-up.There were four excellent and two good according to the score standard of Xu Shaoting.Conclusion The pull-out wire technique in the treatment of patellar layered fracture which is rare and easy to misdiagnosed in clinic,represents simple and convenient,and it can be attempted to apply in this complex fractures.