双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折

Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole

目的:探讨双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折的临床疗效。方法:2018年1月至2020年6月采用双滑轮结合缝线桥技术治疗15例髌骨下极粉碎性骨折患者,其中男9例,女6例,年龄28~68(42.4±9.6)岁。患者伤后均有明显膝关节疼痛及活动受限,均行膝关节X线和CT检查,明确为髌骨下极粉碎性骨折。术后定期拍摄膝关节X线片了解骨折愈合情况并测量Insall-Salvati指数,记录关节活动度,并采用Bostman评分系统评价术后膝关节功能。结果:15例患者均获得随访,随访时间7~24(11.4±4.2)个月,无明显膝前痛病例。末次随访时患肢膝关节活动度为105°~140°(128.5±12.8)°,Insall-Salvati指数为0.79~1.12(0.92±0.18)。X线片提示髌骨均骨性愈合,未见锚钉脱落、断裂及骨折块移位等情况。Bostman髌骨骨折功能评分(27.85±2.06)分,优13例,良2例。结论:双滑轮技术结合缝线桥技术治疗髌骨下极粉碎性骨折复位固定可靠,术后患者可早期开始功能锻炼。

Objective To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.Methods From January 2018 to June 2020,15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology,including 9 males and 6 females,aged 28 to 68 years old with an average of(42.4±9.6)years old.All patients had obvious knee joint pain and limited movement after injury.All knee joints were examined by X-ray and CT,which confirmed that they were all comminuted fractures at the lower level of the patella.After operation,X-ray films of the knee joint were taken regularly to understand the fracture healing,the Insall Salvati index was measure,the range of motion of the joint was recorded,and the function of the knee joint was evaluateed by the Bostman scoring system.Results All the 15 patients were followed up for 7 to 24 months with an average of(11.4±4.2)months,and there was no obvious anterior knee pain.At the last follow-up,the knee joint range of motion of the affected limb was 105°to 140°with an average of(128.5±12.8)°,and the Insall Salvati index was 0.79 to 1.12 with an average of(0.92±0.18).The X-ray film showed that the patella was bone healing,and no anchor fell off,broken,or displaced fracture block was found.Bostman patellar fracture function score was 27.85±2.06,13 cases were excellent,2 cases were good.Conclusion Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella,and patients can start functional exercise early after operation.