膝前正中直切口镍钛聚髌器治疗髌骨粉碎性骨折

目的探讨膝前正中直切口镍钛聚髌器治疗髌骨粉碎性骨折的疗效。方法1999年1月至2005年11月,采用膝前正中直切口镍钛聚髌器治疗新鲜髌骨粉碎性骨折112例,男73例,女39例;年龄18～76岁,平均37.5岁。车祸伤42例,摔伤50例,坠落伤13例,打击伤7例。按Rockwood＆Green分型：粉碎无移位69例,其中碎骨块3～4块者39例、5～6块者27例、大于6块者3例;粉碎有移位43例,其中碎骨块3～4块者28例、5～6块者14例、大于6块者1例。结果103例随访12～36个月,平均20个月。骨折愈合时间2～4个月。术后10～26个月取出内固定,平均12个月。无内固定松动及再骨折。术后发生膝关节滑膜炎2例,健侧深静脉血栓1例,原有骨关节炎一过性加重3例。按Lysholm＆Gillquist膝关节评分标准,优77例,良19例,可7例,优良率93%。结论膝前正中直切口显露充分、操作方便、切口小、不损伤隐神经和膝降动脉髌下支。镍钛聚髌器具有“动力性张力带作用”,可以复位及固定髌骨骨折。对严重的髌骨粉碎性骨折,采用膝前正中直切口结合镍钛聚髌器疗效满意。

Treatment of comminuted patellar fractures with NiTi-Patellar concentrator via genicular anterior midline incision

Objective To investigate the efficacy of the treatment of comminuted patellar fractures with NiTi-Patellar concentrator (NT-PC) via genicular anterior midline incision. Methods One hundred and twelve cases of fresh comminuted patellar fracture were treated with open reduction and internal NT-PC fixation between January 1999 and November 2005. The operations were proceeded through anteromedian approach. The demography of the 112 cases are as follows: 39 males and 73 females, ranging from 18 to 76 years old (a mean of 37.5 years old). The causes for injury included car accident (42 cases), tumble (50 cases), fall (13 cases), and direct strike (7 cases). According to Rockwood & Green classification, there were 69 cases of comminuted fractures without displacement and 43 cases with displacement. In the former group, 39 cases were 3-4 fragments, 27 cases were 5-6 fragments, and 3 cases were more than 6 fragments; and in the latter group, 28 cases were 3-4 fragments, 14 cases were 5-6 fragments, and 1 case was more than 6 fragments. Results One hundred and three cases out of 112 cases were followed up with a mean period of 20 months (12 to 36 months). All patients obtained complete bone union in 2-4 months. No case of implant loosening or refracture was found. The retained NT-PC were removed in 10-26 months postoperation (a mean of 12 months). 2 cases of postoperative traumatic arthritis, 1 case of health side limb deep vein thrombosis, 3 cases of temporary aggravation of pre-existing osteoarthritis were documented as postoperative complications. Of the 103 cases, 77 cases score excellent under the Lysholm & Gillquist Score, 19 good and 7 fair. The excellent and good rate was 93%. Conclusion The anteromedian approach to the knee joint has obvious advantages of better exposure, great convenience to manipulation, shorter incision and less chances of the saphenous nerve and infrapatellar branch of the descending genicular artery injury. The NT-PC fixation is characterized by a dynamic tension band mechanism, it serves the role of reduction and fixation simultaneously. Selecting the anteromedian approach to the knee joint and utilizing NT-PC provide an ideal treatment for severe comminuted patellar fracture.