手术与保守方法治疗髌骨骨折疗效比较

A comparison of conservative and operative treatment for the patellar fracture

目的 探讨髌骨骨折的手术治疗和手法治疗的优缺点。方法 根据患者的X线片和术中所见 ,将手术组和保守组各 1 3例分为横断粉碎型和星状崩裂型两大类 ,分别采用切开复位张力带内固定加CPM机膝关节功能锻炼 ,和手法复位自制髌圈加石膏托外固定加中药熏洗 ,二组均随访半年以上。结果 对两大类型髌骨骨折的治疗总治愈率 ,手术治疗 76 9%显著优于保守治疗 53 8% (P <0 0 5) ,但总有效率 ,手术治疗为 92 3 % ,保守治疗为 1 0 0 % ,两法相比又无显著差异 (P >0 0 5) ,其中对横断粉碎型骨折的治愈率 ,西医组为 1 0 0 % ,中医组为 50 % ;对星状崩裂型 ,手术组为 40 % ,保守组为57 1 %。结论 对横断粉碎型髌骨骨折 ,特别是断端分离超过 2cm者 ,应采用手术治疗 ;而对星状崩裂型 ,特别是全髌粉碎型 。

Objective To investigate the advantage and defect of operation and traditional Chinese manipulation in treating the patellar fracture Methods According to the patients X ray and what was seen in operation,the cases were divided into two groups,including the surgical group (SG) and maneuver group (MG).Each group had 13 cases,which was divided into two types,including the transverse comminuted fracture and the stellate cracked fracture.Open reduction and tensile band internal fixation were used and CPM followed in SG.Hand skill reduction and patella circle made by author himself,plaster support external fixation and Chinese herbs fumigating were used in MG.The cases in two groups were followed up for more than half a year.Results The total curative ratio of treating these two patellar fracture types in SG was 76 9%,superior to MGs 53 8% (P<0 05).The total effective rate in SG was 92 3% and 100% in MGs,respectively.There were no significant difference in these two ways (P>0 05).The curative ratio in transverse comminuted fracture was 100% in SG and 50% in MC.In the mean while,to stellate cracked fracture,the curative ratio was 40% in SG and 57 1% in MG.Conclusion In transverse comminuted patellar fracture,especially the length of end separation exceeded 2 cm,operation should be used.To those stellate cracked fracture,especially to the total patellar comminuted types,we may use hand skill to treat them.