克氏针联合髌骨爪固定治疗髌骨骨折的效果观察

Efficacy of Kirschner wire combined with patella concentrator fixation in treatment of patella fracture

目的观察克氏针与髌骨爪固定联合用于髌骨骨折的治疗效果。方法抽取开封市中心医院2017年3月至2019年1月收治的髌骨骨折患者147例,全部患者均接受切开复位内固定治疗,根据固定物将全部147例患者分为3组:A组(51例)行克氏针内固定;B组(50例)行髌骨爪内固定;C组(46例)行克氏针联合髌骨爪内固定。术后随访12个月,比较3组手术相关指标及随访结束时的膝关节功能恢复优良率;分别于术后1、2、4周,采用视觉模拟评分法(VAS)评价患者手术部位疼痛情况;分别于术后1、2、4、12周,检测并比较各组膝关节屈曲活动度;随访期间观察并记录患者并发症发生情况。结果随访结束时,C组膝关节功能恢复优良率高于A、B组,差异有统计学意义(P<0.05);A、B组比较差异未见统计学意义(P>0.05);3组术中失血量、手术时间、骨折愈合时间比较差异未见统计学意义(P>0.05);组间术后各时点VAS评分比较差异未见统计学意义(P>0.05);与A、B组比较,C组术后各时点的膝关节屈曲活动度高,差异有统计学意义(P<0.05);A、B组比较差异未见统计学意义(P>0.05);3组随访期间均无并发症发生。结论克氏针联合髌骨爪固定治疗髌骨骨折,在不延长手术时间、增加手术失血量、增加并发症风险、增加手术部位疼痛感的情况下,较克氏针或髌骨爪单用更利于患者膝关节功能及关节屈曲度的恢复,安全可靠。

Objective To observe the curative effects of Kirschner wire combined with patella concentrator fixation for patella fracture.Methods A total of 147 patients with patella fracture who admitted in Kaifeng Central Hospital from March 2017 to January 2019 were selected.All patients underwent open reduction and internal fixation.The 147 patients were divided into 3 groups according to the fixation:group A(51 cases)was treated by Kirschner wire internal fixation;group B(50 cases)was treated by patella concentrator internal fixation;group C(46 cases)was treated by Kirschner wire combined with patella concentrator internal fixation.During 12 months of postoperative follow-up,the surgical indexes and the excellent rate of knee joint recovery at the end of follow-up were compared among the three groups;after 1 week,2 weeks,4 weeks of surgery,the visual analogue scale(VAS)was used to evaluate the pain of surgical site of the patients;after 1 week,2 weeks,4 weeks and 12 weeks of surgery,the range of motion of flexion of knee joint in each group was detected and compared;the incidence of complications during follow-up was recorded.Results At the end of follow-up,the excellent rate of knee joint recovery in group C was higher than that in group A and group B(P<0.05);there was no statistical difference between group A and group B(P>0.05);there was no statistical difference in the intraoperative bleeding volume,operation time and fracture healing time among the three groups(P>0.05);there was no statistical difference in the VAS score at each time after surgery between groups(P>0.05);the range of motion of flexion of knee joint in group C at each time after surgery was higher than that in group A and group B(P<0.05);there was no statistical difference between group A and group B(P>0.05);there were no complications in the three groups during follow-up.Conclusions Under the conditions of without prolonging,without prolonging the operation time,increasing the blood loss,the risk of complications and the pain of the operation site,it is more conducive to the recovery of knee joint function and joint flexion than Kirschner wire or patella claw alone,which is safe and reliable.