可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折

背景：髌骨下极粉碎性骨折具有骨折块小、修复髌腱起点困难等特点,临床如何处理粉碎性骨折块及重建髌韧带功能是亟待解决的问题。目的：探讨可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折的方法和临床疗效。方法：2007年8月至2012年12月收治26例髌骨下极粉碎性骨折患者,男15例,女11例;年龄19~65岁,平均42.5岁。患侧髌骨下极粉碎性骨折严重,均无法用克氏针及拉力螺钉固定,术中切除粉碎性骨折块,两枚可吸收带线锚钉依次垂直于髌骨下极,沿骨横截面中轴三等分点拧入,Kessler法缝合髌腱起点,膝关节屈曲90°位8字钢丝减张带固定。结果：术后切口均Ⅰ期愈合,无一例发生并发症。26例中24例获得随访,随访时间为6个月~5年,平均15.6个月。末次随访时,患者疼痛视觉模拟评分（VAS）为（1.0±0.3）分,患侧膝关节活动度（ROM）与健侧比较无统计学差异（P〉0.05）,患侧Lysholm评分优18例、良4例、可1例、差1例,优良率为91.6%。结论：可吸收锚钉联合8字减张带是治疗髌骨下极粉碎性骨折的有效方法,具有并发症少、术后恢复快等优点。

Absorbable anchors combined with 8-shaped decreasing tension band in treating the comminuted fracture of inferior patellar pole

Background： The comminuted fracture of inferior patellar pole is characterized by its small fracture fragments and its diffi- culty in reconstructing the apex of the patellal tendon. How to deal with the comminuted fracture segments and reconstruct the patellal ligament function are the burning questions in clinic. Objective： To investigate the clinical effects of the absorbable anchors and 8- shaped decreasing tension band combined method in treating the comminuted fracture of inferior patellar pole. Methods： From August 2007 to December 2012, 26 patients （15 males and 11 females） with an average of 42.5 （19-65） years old were diagnosed with comminuted fracture of inferior patellar pole. For these patients, the comminuted fracture of in- ferior patellar pole of the affected side was very serious, thus cannot be fixed by kirschner wire and lag screw. During the oper- ation, the comminuted fracture segments were removed. Perpendicular to the inferior patellar pole, 2 absorbable anchors with stitches were screwed into the 2 points which equally divided the axis into 3 parts in the cross section, and sutured the apex of the patellar tendon with Kessler method. Then the knee-joint was fixed with 8-shaped decreasing tension band at a flex of 90. Results： All incisions were healed without any complication by first intention. Twenty-four of the 26 patients were followed up, and the mean follow-up period was 15.6 months （6 months-5 years）. At the last follow-up, the visual analog scores （VAS） of the patients was 1.0-0.3 points, the range of motion （ROM） of the knee-joint had no statistical significance be- tween the affected and the normal side （P〉0.05）. According to the Lysholm knee scores, there were 18 excellent cases, 4 good cases, 1 fair case, and 1 poor case, the excellent-good rate was 91.6%. Conclusions： Absorbable anchors combined with 8-shaped decreasing tension band is an effective method to treat the com- minuted fracture of inferior patellar pole. It has the advantage of few complications and fast recovery.