锚钉联合空心螺钉治疗复杂粉碎性髌骨骨折的临床疗效

Treatment efficacy of complicated comminuted patellar fracture with anchor suture and cannulated compression screws

目的探讨锚钉联合空心螺钉治疗复杂粉碎性髌骨骨折的手术方法及临床疗效。方法对2016年8月-2020年10月收治的23例复杂粉碎性髌骨骨折(AO/OTA分型均为C3型)患者,进行切开复位锚钉联合空心螺钉内固定治疗。术后通过骨折愈合时间、膝关节活动度、Bostman髌骨骨折疗效评分等指标评价手术治疗效果。结果3例患者失访,其中1例术后3个月失访,2例术后6个月失访。术后平均随访时间为(11.5±2.7)个月;骨折平均愈合时间为(10.9±1.4)周;患者均未出现骨折延迟愈合、骨折不愈合、螺钉断裂、切口感染等并发症。末次随访患侧膝关节活动度伸直均为0°,屈曲平均为118.3°±4.8°,双侧膝关节活动度比较,差异无统计学意义(P>0.05);末次随访Bostman髌骨骨折疗效评分平均为(26.3±3.8)分,其中优13例,良5例,差2例,优良率90%。结论锚钉联合空心螺钉能对髌骨复杂粉碎性骨折提供稳定的固定,允许早期功能训练,促进膝关节功能恢复,是髌骨复杂粉碎性骨折的有效治疗方法。

Objective To observe the clinical efficacy of anchor suture and cannulate compression screws on the treatment of complicated comminuted patellar fracture. Methods We performed a retrospective analysis involving 23 patients with complicated comminuted patellar fracture(AO/OTA type C3) from August 2016 to October 2020. The patients were treated by internal fixation with anchor suture and cannulate compression screws in operation. We evaluated the clinical effect with the fracture healing time,knee joint range of motion and Bostman function score at the follow-up time. Results All the patients were fully followed up except for three patients in which one was three months’ follow-up time and the two were six months’. The average follow-up time was 11.5 ±2.7 months of all 23 patients. The mean time of fracture union was 10.9 ±1.4 weeks. The complications such as delayed union, nonunion of fracture, screws broken and wound infection were not found. At the final follow up time, the average range of motion was 0 degree(extension), 118.3 ±4.8 degrees(flexion) respectively. There were no significant differences contrasting to the contralateral knees in all 20 patients(P>0.05). The average knee Bostman function score was 26.3 ±3.8, in which 13 patients were evaluated as excellent, 5 patients as good and 2 patients as poor by the score system. The rate of excellent and good results was 90%.Conclusion The anchor suture and cannulate compression screws can provide stable and effective fixation to patellar fracture. The knee joint functional recovery will be very well after full and early functional exercise. The method is the effective way to treat complicated comminuted patellar fracture.