关节镜下微创无头加压螺钉与髌骨针联合张力钢丝固定治疗髌骨骨折的临床观察

目的:探究关节镜下微创无头加压螺钉(headless compression screw,HCS)与髌骨针联合张力钢丝固定治疗髌骨骨折的临床优势。方法:回顾性分析髌骨骨折患者56例,15例采用传统切开复位克氏针张力带钢丝固定术的患者为A组,18例实施关节镜下微创HCS内固定术患者为B组,23例进行关节镜下微创髌骨针联合张力钢丝固定术患者为C组,比较3组患者手术时间、术中出血量、骨折愈合情况、关节恢复情况以及术后并发症。结果:A、B、C组手术时间分别为(79.3+8.4)min、(52.2+7.3)min、(61.5+7.8)min,差异有统计学意义(P<0.05);A、B、C组患者术中出血量分别为(61.5+8.7)mL、(34.4+5.8)mL、(35.6+4.9)mL,B、C组患者术中出血量差异无统计学意义(P>0.05),B、C组与A组比较,差异有统计学意义(P<0.05);B、C组患者膝关节功能优良率、膝关节活动优良率以及骨折复位优良率均高于A组患者,差异有统计学意义(P<0.05),B、C组之间的疗效差异无统计学意义(P>0.05);A组4例(26.7%)患者出现术后并发症,分别为术后感染2例,内固定物脱落1例,内固定物断裂1例;B组和C组在随访期间均未出现术后并发症。结论:关节镜下微创术结合HCS用于髌骨横型骨折、结合自折式髌骨针联合张力带钢丝内固定用于髌骨粉碎性骨折临床疗效确切,与传统手术相比,手术时间短,损伤小,膝关节功能恢复快,内固定可靠,术后并发症少,值得推广应用。

Clinical observation of headless compression screw fixation and patellar needle combined with tension wire fixation in the treatment of patellar fracture under arthroscope

Objective:To explore the advantages of headless compression screw(HCS) fixation and patellar needle combined with tension wire fixation in the treatment of patellar fracture under arthroscope.Methods:56 cases of patellar fracture patients were given retrospective analysis.15 cases were treated with traditional open reduction and Kirschner wire fixation were selected as group A, 18 cases of HCS fixation under arthroscope were selected as group B,23 cases of patients treated with patella needle combined with ten-sion wire fixation under arthroscope were selected as group C.The operation time,intraoperative bleeding volume,fracture healing,joint recovery and postoperative complications in the three groups were compared.Results:The operation time of group A,group B and group C was (79.3+8.4) min,(52.2+7.3) min,(61.5+7.8) min,the difference was statistically significant(P<0.05).The amount of bleeding in group A,group B and group C was (61.5+8.7) mL,(34.4+5.8) mL and (35.6+4.9) mL,there was no significant difference between group B and group C (P>0.05),there was significant difference between group B(C) and group A(P<0.05). The excellent rate of knee joint function,knee joint movement and fracture reduction in group B and group C were higher than those in group A,the difference was statistically significant (P<0.05).There was no significant difference between the group B and the group C (P>0.05).In group A,4 cases (26.7%) had postoperative complications, including 2 cases of postoperative infection,1 case of internal fixation loss,1 case of internal fixation fracture,but no complications occurred in group B and group C during the follow-up pe-riod.Conclusions:The minimally invasive surgery combined with HCS under arthroscope for patellar transverse fractures,self folding patellar needle combined with tension band wire fixation for comminuted patellar fracture has definite clinical effect.Compared with the traditional operation,the operation time is shorter,the injury is less,the knee joint function recovery is faster, the internal fixation is more reliable,and the postoperative complications are less,so it is worthy of application.