预断式带孔克氏针张力带结合PDS Ⅱ线荷包缝合治疗髌骨粉碎性骨折

Pre-fracture type kirschner wire tension band combined with PDS Ⅱ purse-string suture for the treatment of comminuted patella fracture

目的探讨预断式带孔克氏针张力带结合PDS II线荷包缝合治疗髌骨粉碎性骨折的临床效果。方法回顾性分析2016年1月—2019年1月恩施土家族民族自治州民族医院骨伤科收治的髌骨粉碎性骨折患者56例,男性38例,女性18例;年龄21~64岁,平均39.5岁。按治疗方式不同分为张力带组(采用预断式带孔克氏针、钢丝张力带固定)和联合组(采用预断式带孔克氏针张力带联合PDS II线荷包缝合固定),各28例。张力带组男性20例,女性8例;年龄22~63岁,平均38.8岁;摔伤8例,重物砸伤5例,道路交通伤12例,其他伤3例。联合组男性18例,女性10例;年龄21~64岁,平均40.9岁;摔伤9例,重物砸伤2例,道路交通伤13例,其他伤4例。比较两组患者手术时间、术中出血量、术后1年膝关节活动度、Btistman髌骨骨折功能评分。结果患者均得到门诊、电话或微信随访,时间12~15个月,平均13.9个月。张力带组平均手术时间(78.3±11.4)min、术后出血量(43.9±8.5)mL与联合组(83.6±13.5)min、(44.9±10.4)mL比较,差异均无统计学意义(P>0.05),联合组术后1年膝关节活动度(126.7±6.3)°、Btistman髌骨骨折功能评分优良率96%显著优于张力带组(103.9±5.4)°、71%,差异有统计学意义(P<0.05)。结论预断式带孔克氏针张力带结合PDS II线荷包缝合治疗髌骨粉碎性骨折,能更好地恢复膝关节功能,是一种适合复杂性髌骨粉碎性骨折的有效治疗方法。

Objective To investigate the clinical effects of pre-fracture type Kirschner wire tension band combined with PDS II purse-string suture in treating comminuted patella fracture.Methods A total of 56 patients with comminuted fracture of the patella(38 males and 18 females aging from 21 to 64 years,with an average age of 39.5 years admitted to the Department of Orthopedics and Traumatology of the National Hospital of Enshi Autonomous Prefecture of Tujia and miao from Jan.2016 to Jan.2019 were retrospectively analyzed.According to different treatment methods,the patients were divided into tension band group(fixed with pre-broken Kirschner wire with hole and steel-wire tension band)and combination group(fixed with pre-broken Kirschner wire tension band with hole combined with purse-string suture with PDS II suture),with 28 patients in each group.In the tension band group,there were 20 males and 8 females,with an average age of 38.8 years(range,22-63 years).Among them,8 patients were injured by falling,5 by heavy objects,12 by road traffic accidents and 3 by other causes.The combination group included 18 males and 10 females,with an average age of 40.9 years(range,21-64 years).Among them,9 patients were injured by falling,2 by heavy objects,13 by road traffic accidents and 4 by other causes.The surgical duration,intraoperative blood loss,knee joint range of motion and Btistman functional score for patellar fracture were compared between the two groups.Results All the patients were followed up by outpatient service,telephone or Wechat for 12-15 months,with an average of 13.9 months.The average surgical duration of the tension band group was(78.3±11.4)minutes,which was longer than that of the combination group(83.6±13.5)minutes,without statistically significant difference(P>0.05).The intraoperative blood loss was(43.9±8.5)mL in the tension band group and(44.9±10.4)mL in the combination group,showing no statistically significant difference(P>0.05).The knee joint range of motion(126.7±6.3)°and the excellent and good rate of Btistman functional score for patellar fracture(96%)in the combination group were significantly higher than those in the tension band group[(103.9±5.4)°,71%,P<0.05].Conclusions Pre-broken Kirschner wire tension band combined with purse-string suture with PDS II suture in the treatment of comminuted fracture of the patella can better restore the knee joint function,and is an effective treatment method suitable for complex comminuted fracture of the patella.