髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩

目的:探讨髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩的疗效。方法:陈旧性髌骨骨折合并股四头肌挛缩患者13例,男9例,女4例;年龄20~46岁,平均37岁。受伤至手术时间6周~8个月,平均4个月。骨折分类:横形骨折8例,粉碎性骨折4例,髌骨下极骨折1例。骨折分离移位情况:<2cm者4例,2~3cm者7例,>3cm者2例。被动屈膝10°~20°者5例,21°~50°者7例,>50°者1例。用克氏针在骨折块的上1/3处行骨牵引,牵引过程中可同时配合CPM锻炼膝关节。1~2周后拍片证实两断端靠近后再行切开复位内固定术。结果:13例均获得随访,随访时间8~36个月。根据王亦璁改良膝关节功能评分法,本组优8例,良4例,可1例。骨折均获得I期愈合,髌骨的解剖结构恢复,功能恢复良好。结论:陈旧性髌骨骨折合并股四头肌挛缩骨折端分离,I期手术复位困难,而先行髌骨牵引后再行切开复位张力带固定,不但解决了股四头肌挛缩,有利于骨折的复位固定,而且保留了髌骨结构,保证了伸膝装置的完整性。     

髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩

目的:探讨髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩的疗效。方法:陈旧性髌骨骨折合并股四头肌挛缩患者13例,男9例,女4例;年龄20⁴6岁,平均37岁。受伤至手术时间6周⁸个月,平均4个月。骨折分类:横形骨折8例,粉碎性骨折4例,髌骨下极骨折1例。骨折分离移位情况:<2cm者4例,2³cm者7例,>3cm者2例。被动屈膝10°²0°者5例,21°⁵0°者7例,>50°者1例。用克氏针在骨折块的上1/3处行骨牵引,牵引过程中可同时配合CPM锻炼膝关节。1²周后拍片证实两断端靠近后再行切开复位内固定术。结果:13例均获得随访,随访时间8³6个月。根据王亦璁改良膝关节功能评分法,本组优8例,良4例,可1例。骨折均获得I期愈合,髌骨的解剖结构恢复,功能恢复良好。结论:陈旧性髌骨骨折合并股四头肌挛缩骨折端分离,I期手术复位困难,而先行髌骨牵引后再行切开复位张力带固定,不但解决了股四头肌挛缩,有利于骨折的复位固定,而且保留了髌骨结构,保证了伸膝装置的完整性。     

阔筋膜移植修补延长髌韧带治疗髌骨骨不连术后髌韧带挛缩

目的探讨阔筋膜移植修补延长髌韧带治疗髌骨骨不连术后髌韧带挛缩临床效果。方法本组6例,男4例,女2例;年龄20～62岁,平均31.7岁;髌骨骨不连治疗方法：镍钛合金聚髌器4例,张力带钢丝辅助聚髌器2例。髌骨骨折距本次手术时间5～20个月,骨不连手术距本次手术时间4～8个月。均应用同侧阔筋膜移植＋人工韧带辅助加固重建并延长髌韧带。结果 6例均得到随访,随访时间5～24个月,平均13个月。本组6例患者术后3～5个月均获明显的关节功能改善,X线摄片髌骨上下极之间长度与重建髌韧带比例均达到或接近1：1。髌骨高度得到恢复,未发生继发性髌韧带损伤。按照Lysholm膝关节评分,术前（34.67±4.18）与术后（44.17±2.48）比较,差异具有统计学意义（t=4.456,P〈0.05）。Insall指数,即髌腱长度与髌骨长度之比,术前（0.837±0.04）与术后（1.055±0.04）比较差异具有统计学意义（t=9.083,P〈0.05）。结论阔筋膜移植修补延长髌韧带符合生物力学原理,是治疗髌骨骨不连术后髌韧带挛缩的有效方法,通过手术充分的软组织松解、重建髌韧带长度、恢复髌骨高度、阔筋膜移植加固及及术后早期进行＂主动、渐进、增强＂太极式功能锻炼能够获得满意的治疗效果。     

高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂

目的 探讨陈旧性髌腱断裂的临床特点,介绍采用高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂的手术方法 和术后康复方法 .方法 2002年1月至2007年2月,收治陈旧性髌腱断裂6例,手术切断超长的瘢痕愈合髌腱组织.恢复长度后重新吻合,并在胫骨结节和髌骨两端钻骨孔,采用4根高强度聚酯纤维缝线经骨孔减张保护.术后对患者采用积极的康复锻炼方案:术后第1天即町下地直立行走及被动屈膝90°,休息和睡眠时不须支具石膏固定保护;术后3周起开始练习主动抬腿;术后6周后开始练习快走,负重2 kg直腿抬高;术后12周后开始练习上下楼梯和下蹲;术后6个月后开始正常运动以及蹬跳运动.结果 术后随访1～5年,平均3.2年.患者早期即可以活动并可以下床直立行走,所有患者均未出现再断裂.手术6个月以后,患者均恢复正常的平地行走、跑步能力等,屈膝基本达到对侧的水平,股四头肌力量良好.Lysholm评分均能达到100分.结论 高强度聚酯纤维缝线减张治疗陈旧性髌腱断裂,创伤小,方法 简单,不须外加牵引,不须石膏固定,不须二次手术取内固定.积极的康复训练允许患者早期行走,效果可靠.     

游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带治疗复发性髌骨脱位

目的 探讨游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带治疗复发性髌骨脱位的疗效.方法 1999年3月至2008年1月共收治57例复发性髌骨脱位患者,男19例,女38例;年龄17～29岁,平均24.3岁;首次脱位至手术时间为1～4年,平均2.6年.行髌内侧支持带和髌股韧带修补手术15例（A组）,经髌骨骨隧道自体游离半腱肌腱重建内侧髌股韧带19例（B组）,自体游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带23例（C组）.术后12个月按照Insall标准和Lysholm评分评价结果,并比较3种术式的疗效.结果 所有患者术后获12～37个月（平均18个月）随访.术前与术后12个月Lysholm评分A组平均分别为（80.3±2.9）、（89.6±3.7）分,B组平均分别为（80.9±3.1）、（94.6±3.4）分,C组平均分别为（81.2±3.9）、（93.6±4.1）分,3组患者术前与术后12个月Lysholm评分比较差异均有统计学意义（P〉0.05）.3组患者之间术前Lysholm评分比较差异无统计学意义（P〉0.05）;术后12个月B组与C组Lysholm评分差异无统计学意义（P〉0.05）,但均优于A组,差异有统计学意义（P〈0.05）.3组患者疗效按Insall标准评定：优良率分别为80.0%、94.7%、95.6%,3组间差异无统计学意义（P〉0.05）.结论 锚钉固定技术加强膝内侧髌股韧带的方式具有手术方式简单、损伤小、髌骨稳定性好、并发症少等优点,是治疗复发性髌骨脱位的一种良好选择.     

带腱骨瓣移位术治疗陈旧性髌骨骨折

带腱骨瓣移位术治疗陈旧性髌骨骨折姜振国，刘明远，郝跃峰，刘学光，张瑞我科自１９８９年开始，采用带腱骨瓣翻转移位术治疗陈旧性髌骨骨折，取得了满意的效果。１临床资料本组１３例，均为男性。年龄１８～６１岁。平均４０岁。病程最长６年，最短半年，平均３年。全部...     

应用抓髌器治疗髌骨骨折的体会

应用抓髌器治疗各型髌骨骨折528例,优良率97%。抓髌器具有不切开皮肤和关节囊,不会加大软组织损伤,有利于骨折整复和固定的优点。生物力学测定证实能够维持加压固定。     

髌骨-胫骨结节钢丝固定髌韧带旷置术治疗髌骨下极骨折的疗效观察

目的 探讨应用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗髌骨下极骨折的临床疗效.方法 采用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗髌骨下极骨折19例,术后逐步开展膝关节功能锻炼.结果 随访5～24个月,平均19个月.未发现钢丝断裂及钢丝切割骨折病例.结论 采用跨髌骨-胫骨结节钢丝8字固定髌韧带旷置术治疗能有效地复...     

动态髌骨牵引固定器治疗陈旧髌腱断裂

目的 探讨陈旧髌腱断裂的修复方法。方法 设计“井”形固定器，在动态条件下，将髌骨复位、股四头肌松懈、髌腱修补及术后带固定器活动。结果 治疗6例，随访时间8～56个月，平均2.6个月，膝关节伸屈活动取得了满意的治疗效果。结论 应用“井”形外固定器动态下，治疗陈旧性髌腱断裂，解决了髌腱、股四头肌挛缩，又有利于缝合修复后固定，还可早期练习膝关节功能。方法简单，是一种较为合理的新的治疗方法。     

Tibial tubercle fracture with avulsion of patellar ligament

Combined fractures of the tibial tubercle and the patellar ligament are rare. Here we report the case of an 18-year-old boy who fell to the ground while playing basketball and suddenly felt a pop in his left knee; thereafter he was unable to stand. In-hospital radiographic examination revealed a tibial tubercle fracture with a high-riding patella, and the diagnosis was a Salter-Harris type IV tibial fracture associated with a sleeve fracture. The patient underwent surgery using a wire loop, an Ethibond suture (Ethicon Inc., Somerville, NJ, USA), and a staple to repair the site of the injury. The knee was immobilized for 4 weeks and after 2 months of follow-up, the patient was pain free with normal motion and strength. In conclusion, combined tibial tubercle fracture and avulsion of the patellar ligament are rare. The authors assert that the repair technique that is described herein supports reduced pain, early rehabilitation, and successful outcomes.     

Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature

Simultaneous occurrence of tibial tubercle fracture and patellar tendon avulsion with double-hit injury of the knee extensor mechanism is an extremely rare condition. However, they become more frequent due to increased participation in sports and high-energy recreational activities at younger age. It represents a frequently missed diagnosis; therefore, high index of suspicion is required for the diagnosis of such injuries to avoid delays in the treatment which would lead to possible suboptimal functional outcome. Only few case reports of such injuries were reported in the literature with limited information regarding frequency, diagnosis, and outcome in children. To the best of our knowledge, this is the first case series with such type of injury.

     

Ventralization of the tibial tubercle for patellar pain

Summary In this study patellar pain in 37 knees was treated by ventralization of the tibial tubercle. No primary arthrotomy was performed. Seventy-three percent of the knees improved in the opinions of the patients, 11% remained unchanged, and 16% grew worse. Extension did not deteriorate in any knee. No serious complications were encountered. Seven patients had to undergo reoperation. It is suggested that patellar pain should be subdivided into that due to excess pressure, that due to instability, and that due to excess intraosseous venous pressure, in order to find a treatment appropriate to the cause in each case.     

Antero-medialisation of the tibial tubercle for patellar instability

We reviewed 19 patients (24 knees) with patellofemoral instability treated surgically with antero-medialisation of the tibial tubercle and lateral retinacular release. Twenty-two knees had recurrent patellar dislocation and two patellar subluxation. Lateral retinacular release was performed arthroscopically in 15 knees. Average follow-up was 52 (16–86) months. There was one postoperative haemarthrosis and one failed fixation, which needed surgical revision. The average Lysholm score improved from 63.3 to 98 and only one knee had persistent patello-femoral pain postoperatively. The patellar tilt angle improved from 9.4° to 5.5°. There were no redislocations. We find that the surgical technique produces a consistent correction of patellar instability, but long-term studies are needed to confirm whether it can prevent arthritic degeneration.

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Résumé Nous avons examiné 19 malades (24 genoux) avec une instabilité rotulienne traitée chirurgicalement par antéro-médialisation du tubercule tibial et ouverture de l'aileron externe. Vingt-deux genoux avaient une luxation rotulienne périodique et deux une subluxation rotulienne. La section de l'aileron externe a été faite sous arthroscopie dans 15 genoux. Le suivi moyen était de 52 (16–86) mois. Il y avait une hémarthrose postopératoire et un échec de fixation qui a nécessité une révision chirurgicale. Le score moyen de Lysholm a été amélioré de 63,3 à 98 et un seul genou avait une douleur rotulienne persistante postopératoire. L'angle d'inclinaison rotulien a été amélioré de 9,4° à 5,5°. Il n'y avait pas de nouvelle luxation. Nous pensons que cette technique chirurgicale corrige correctement l'instabilité rotulienne, mais des études à long terme sont nécessaires pour confirmer si elle peut prévenir la dégénérescence arthrosique.

     

Ventralization of the tibial tubercle for patellar pain

In this study patellar pain in 37 knees was treated by ventralization of the tibial tubercle. No primary arthrotomy was performed. Seventy-three percent of the knees improved in the opinions of the patients, 11% remained unchanged, and 16% grew worse. Extension did not deteriorate in any knee. No serious complications were encountered. Seven patients had to undergo reoperation. It is suggested that patellar pain should be subdivided into that due to excess pressure, that due to instability, and that due to excess intraosseous venous pressure, in order to find a treatment appropriate to the cause in each case.     

翻转复位法治疗粉碎性髌骨骨折

2006年12月～2011年6月,我科采用髌骨翻转复位关节面直视下固定法治疗严重粉碎性骨折患者21例,疗效较好,报道如下。