不可吸收缝合线捆扎结合髌骨爪固定治疗髌骨下极骨折疗效观察

Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures

目的探讨不可吸收缝合线捆扎骨折块结合髌骨爪固定治疗髌骨下极骨折的临床疗效。方法2016年9月—2019年1月,收治22例髌骨下极骨折患者。其中男12例,女10例;年龄32~67岁,平均49.1岁。致伤原因:交通事故伤8例,跌伤12例,其他伤2例。根据Rockwood分型均为Ⅲ型。受伤至手术时间3~7 d,平均4.4 d。手术以克氏针由髌骨近侧骨折块表面向后下钻取3~4个骨道;在腰椎穿刺针及钢丝引导下,以不可吸收缝合线纵向穿过髌骨骨道并环绕下极骨折块捆扎复位;最后再以髌骨爪纵向环抱髌骨加强固定。术后观察并发症发生情况,测量膝关节最大活动度,行X线片检查并记录骨折愈合时间,按照B?stman髌骨骨折功能评分评估患膝关节功能恢复情况。结果22例患者均获随访,随访时间12~36个月,平均19.4个月。随访期间无感染、关节僵直、骨不连、复位丢失及内固定物移位等并发症发生。骨折均获临床愈合,愈合时间为2~3个月,平均2.6个月。末次随访时,膝关节最大活动度为130°~135°,平均132.6°。患膝B?stman髌骨骨折功能评分为28~30分,平均29.2分;功能评价均获优。结论不可吸收缝合线捆扎结合髌骨爪固定治疗髌骨下极骨折具有操作简便、固定可靠、并发症少的优点,临床疗效满意。

Objective To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures.Methods Between September 2016 and January 2019,22 patients with inferior patella fractures were treated.There were 12 males and 10 females,with a mean age of 49.1 years(range,32-67 years).The causes of injury were traffic accident in 8 cases,falling in 12 cases,and other causes in 2 cases.The interval from injury to operation was 3-7 days(mean,4.4 days).For the operation,3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires;under the guidance of lumbar puncture needles and steel wires,non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment,then tighten to achieve a satisfactory reduction of the fracture;finally,the patella claw was used to strengthen the fixation.During the follow-up,complications were observed,maximum motion range of the knee joint was measured,X-ray examination was performed and fracture healing time was recorded.The knee function was evaluated according to B?stman scores.Results All the 22 patients were followed up 12-36 months(mean,19.4 months).No infection,joint stiffness,bone nonunion,loss of reduction,or displacement of internal fixation occurred.All fractures were clinically healed,and the bone healing time was 2-3 months(mean,2.6 months).At last follow-up,the maxium motion range of knee joint was 130°-135°,with an average of 132.6°.The B?stman score of the affected knee was 28-30(mean,29.2).All cases were graded as excellent results.Conclusion Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation,reliable fixation,and few complications,and the clinical results are satisfactory.