克氏针张力带治疗高龄骨质疏松患者髌骨骨折的疗效分析

Curative Effect of Kirschner Wire Tension Band to Treat Patella Fractures in Elderly Patients with Osteoporosis

目的探讨克氏针张力带治疗高龄骨质疏松性髌骨骨折的疗效分析。方法纳入2018年1月至2020年1月我院收治的高龄骨质疏松性髌骨新鲜骨折患者36例,其中男7例,女29例,年龄70~88岁,中位年龄数为79岁;骨质疏松症患者17例,重度骨质疏松症患者19例;术前轻度膝关节炎患者26例;中度膝关节炎患者10例;均接受克氏针重张力带内固定治疗,记录骨折愈合时间、并发症发生情况,随访观察患者克氏针松动及Bostman髌骨骨折临床疗效评分。结果①本组手术时间60~130 min,中位数89 min;术中出血量105~160 ml,中位数140 mL。②36例髌骨骨折均愈合,愈合时间2~3个月。③随访4~19个月,平均为9.6个月;36例患者无伤口感染。④内固定松动24例;松动率为66%;松动时间为术后1~8个月;平均3.2个月;⑤Bostman髌骨骨折功能评分优3例,良19例,差14例;术后轻度关节炎患者为9例约为25%;中度膝关节炎患者10例约为27%;重度膝关节炎患者17例,约为47%。结论克氏针张力带固定治疗高龄骨质疏松性髌骨骨折虽然骨折能全部愈合,但患者的克氏针松动率高,需二次手术取出内固定,膝关节功能较术前差,并导致膝关节炎较术前明显的加重。

Objective To explore the curative effect of Kirschner wire tension band in treating patella fractures in elderly patients with osteoporosis.Methods From January 2018 to January 2020,36 elderly patients with osteoporosis patella fresh fractures admitted to our hospital were enrolled,including 7 males and 29 females aged 70~88 years with a median age of 79 years.There were 17 patients with osteoporosis,19 patients with severe osteoporosis.Before operation,there were 26 patients with mild knee arthritis and 10 patients with moderate knee arthritis that all received Kirschner wire heavy tension band internal fixation.Fracture healing time and complications were recorded.Clinical efficacy scores of Kirschner wire loosening and Bostman patella fracture were followed up.Results Operation time was 60~130 minutes with a median of 89 minutes,and intraoperative blood loss was 105~160 ml with a median of 140 ml.36 cases of patella fractures were healed with healing time of 2~3 months.Follow-up was 4~19 months with an average of 9.6 months.36 cases had no wound infection.There were 24 cases of internal fixation loosening with 66%loosening rate.Loosening time was 1~8 months after operation with average 3.2 months.Bostman patella fracture function score was excellent in 3 cases,good in 19 cases,and poor in 14 cases.After operation,9 cases of mild arthritis were about 25%,10 cases of moderate knee arthritis were about 27%,17 cases of severe knee arthritis were about 47%.Conclusion When Kirschner wire tension band fixation is used to treat elderly osteoporosis patella fractures,fracture could be fully healed,but Kirschner wire loosening rate is high that requiring a second operation to remove internal fixation and knee joint function is worse than before operation,which knee arthritis is significantly worse than before surgery.