经髌韧带和胫骨结节双钢丝固定治疗髌骨下极骨折临床分析

目的探讨经髌韧带和胫骨结节双钢丝固定治疗髌骨下极粉碎性骨折的疗效。方法对41例髌骨下极粉碎骨折患者采用经髌韧带钢丝环和髌骨-胫骨结节"8"字钢丝联合固定,回顾性分析患者的临床资料。结果对41例患者随访7~24个月,根据疗效评价标准,优良率90.2%。无骨折移位、钢丝断裂及钢丝切割骨折等并发症。结论经髌韧带和胫骨结节双钢丝固定治疗髌骨下极粉碎性骨折,具有操作简便、复位固定可靠稳定、疗效好、费用低等优点,是有效的手术方法。     

经胫骨结节穿钢丝固定治疗髌骨中、下极粉碎性骨折

目的：观察经胫骨结节穿钢丝固定治疗髌骨中,下极粉碎性骨折的治疗效果。方法：经髌骨近断端横形钻孔与胫骨结节钻孔联合穿钢丝固定治疗髌骨中,下极粉碎性骨折21例。结果：经临床观察和随访,治疗效果满意,结论：该手术操作简单,复位效果好,固定牢靠,不需外固定。     

髌骨下极粉碎性骨折保留下极内固定手术新方法

目的介绍一种采用锚钉技术复位骨折、髌韧带重建加固、联合跨髌腱"8"字钢丝内固定技术在髌骨下极粉碎性骨折保留髌骨下极手术新方法的临床疗效分析。方法采用保留髌骨下极碎骨块、应用锚钉锚入髌骨体行骨折复位、髌韧带重建加固,联合跨髌腱经髌骨、胫骨结节"8"字钢丝减张内固定治疗髌骨下极粉碎性骨折18例。结果随访1年,骨折复位良好并全部愈合。按陆裕朴疗效评定标准:优15例,良3例。结论该方法操作简单、方便、疗效确切,对髌骨下极粉碎性骨折提供双重稳定可靠的内固定及髌韧带重建修补的治疗作用。     

髌骨-胫骨结节架桥式固定结合张力带治疗髌骨下极粉碎性骨折

髌骨骨折一种临床常见的关节内骨折,对于下极粉碎性骨折传统方法治疗并发症很多,不能满足有效固定及早期锻炼的要求.笔者自2003年2月～2008年7月,采用髌骨一胫骨结节架桥式固定结合张力带治疗31例髌骨下极粉碎性骨折,克服了单纯张力带固定以及传统荷包缝合或下极切除术的缺点,取得了满意的疗效.现报告如下.     

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...     

骨针钛缆系统结合可吸收线下极成形治疗髌骨下极粉碎性骨折

目的介绍一种应用骨针钛缆系统结合可吸收线将粉碎性髌骨下极骨折块编织成形对髌骨下极粉碎性骨折保留下极行内固定手术治疗的新方法及临床疗效分析。方法在髌骨下极粉碎性骨折治疗中保留下极,使用可吸收线编织缝合将髌韧带及下极碎骨块编织成形后,运用骨针钛缆系统行髌骨下极粉碎性骨折内固定治疗28例。结果按照陆裕朴疗效评定标准:28例中愈合优21例,良7例,膝关节功能恢复良好。结论结合可吸收线将髌骨下极粉碎性骨折块编织成形后,应用骨针钛缆内固定系统复位髌骨上下极骨折端,并行较强内固定的新技术治疗髌骨下极粉碎性骨折,其手术操作简单、方便,固定牢靠,可行早期膝关节功能锻炼,术后恢复良好。     

髌骨固定于胫骨结节治疗髌骨下极骨折

髌骨骨折是一种常见的关节内骨折 ,手术内固定的方法很多 ,但对下极骨折 ,尤其是粉碎性骨折目前尚没有一种满意的定型术式 ,满足骨折良好的复位 ,坚强的固定及早期关节功能锻炼的综合要求。我院自 1998～ 2 0 0 0年用髌骨固定于胫骨结节治疗髌骨下极骨折 18例 ,取得了满意的疗效。1　疗效资料1.1　一般资料本组 18例 ,男 13例 ,女 5例 ,年龄 19～ 6 2岁 ,平均 38岁 ,左侧 7例 ,右侧 11例 ,均为新鲜骨折 ,其中横断骨折 8例 ,粉碎性骨折 10例 ,合并髌韧带撕裂 11例 ,开放性骨折 1例。1.2　手术方法取伸膝位“Ｓ”形或“Ｙ”形切口 (即常规髋下…     

改良髌骨胫骨结节环扎技术治疗髌骨下极骨折

目的探讨改良髌骨胫骨结节环扎技术治疗髌骨下极骨折的手术方法及疗效。方法对19例髌骨下极骨折采用改良髌骨胫骨结节环扎技术内固定治疗。结果 17获得随访,骨折全部愈合。按胥少汀等分级标准评定:优15例,良1例,可1例。未发现空心钉松动及断裂,术后2个月钢丝断裂2例,均未影响骨折愈合。结论双空心螺钉髌骨胫骨结节环扎技术,较其他方法有一定优势,患者可以早期功能锻炼,临床值得推广。     

分体式髌骨板内固定结合可吸收缝线治疗髌骨下极粉碎性骨折

目的探讨采用分体式髌骨板内固定结合可吸收缝线治疗髌骨下极粉碎性骨折的临床疗效。方法回顾性分析采用分体式髌骨板结合可吸收缝线治疗髌骨下极粉碎性骨折31例的临床资料。结果 31例获得1~24个月随访,骨折均愈合,无感染及分体式髌骨板松动、断裂、骨折移位、关节僵硬等并发症。按照Bostman评分标准:优30例,良1例。结论采用分体式髌骨板内固定结合可吸收缝线治疗髌骨下极粉碎性骨折的临床疗效满意,术后早期负重,较快恢复到伤前关节活动水平,有利于提高患者生活质量。     

经髌骨胫骨结节环形钛缆治疗髌骨下极骨折的效果分析

背景:髌骨下极骨折是常见的关节外骨折,治疗时存在一定困难,经髌骨胫骨结节环形钛缆固定为髌骨下极骨折治疗提供了新的思路。目的:分析经髌骨胫骨结节环形钛缆固定治疗髌骨下极骨折的效果。方法:回顾性分析2014年2月至2016年2月经髌骨胫骨结节环形钛缆固定治疗45例髌骨下极骨折患者的临床资料,根据患者术后随访情况评价治疗效果。结果:45例患者骨折部位左侧23例,右侧22例;受伤至治疗时间3~11 h,平均(5.2±1.5)h。手术时间82~146 min,平均(112.6±22.6)min,术中出血量80~350 ml,平均(202.6±70.7)ml,术后无明显并发症。45例全部获得随访,随访时间为16~36个月,平均(20.6±4.8)个月,术后6周随访时骨折均达到临床愈合。Insall-Salvati指数为0.9~1.2,平均1.1±0.1;Bostman评分为24~30分,平均(27.3±2.0)分。结论:经髌骨胫骨结节环形钛缆固定治疗髌骨下极骨折效果满意,不影响患膝关节术后功能,可作为一种临床治疗方案。     

髌骨下极撕脱粉碎性骨折合并髌韧带损伤的治疗

目的探讨髌骨下极撕脱粉碎性骨折合并髌韧带损伤的治疗方法与临床效果。方法 2003年1月-2008年12月,采用镍钛记忆合金聚髌器内固定及阔筋膜移植修复5例交通事故伤致髌骨下极撕脱粉碎性骨折合并髌韧带损伤。其中男3例,女2例;年龄20～48岁,平均33.7岁。骨折程度:3例髌骨下极3个骨折块,2例4个骨折块;髌韧带损伤情况:3例韧带中段横型撕裂,1例近胫骨结节处斜型撕裂,1例纵向撕裂尚未完全离断。受伤至手术时间为1～5 d。结果患者术后切口均Ⅰ期愈合,无感染、深静脉血栓形成等并发症发生。术后第2天复查X线片示髌骨高度与髌韧带长度比例恢复1∶1。5例均获随访,随访时间10～22个月,平均18个月。术后3～12周4例患侧膝关节屈曲度达健侧水平,1例膝关节屈曲功能稍差(约100°)。术后3～5个月骨折均达骨性愈合。术后12～15个月取出聚髌器,均未发生骨折复位丢失或再骨折。随访期间无骨折块移位、植入物松动和断裂、髌韧带再次断裂等并发症发生。末次随访时根据张春才等膝关节评分标准评定疗效:获优3例,良1例,可1例,优良率80%;根据胥少汀等综合评分法评定膝关节功能:获优2例,良2例,中1例,优良率80%。结论镍钛记忆合金聚髌器内固定联合阔筋膜移植修复髌骨下极撕脱粉碎性骨折合并髌韧带损伤可有效恢复伸膝装置的完整性,内固定充分可靠,局部应力诱导成骨,结合术后早期功能锻炼能获得满意疗效。     

Hook plating in patella fractures

PurposeTension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating.MethodsWe enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively.ResultsNine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0–2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7–24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110–145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74–95), with 13 excellent, 14 good, 3 fair, and no poor cases.ConclusionThis study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.     

可吸收线网兜样编织结合张力带钢丝在髌骨下极粉碎性骨折中的临床应用

目的:探讨可吸收线网兜样编织结合张力带钢丝固定治疗髌骨下极粉碎性骨折的临床疗效。方法 :自2012年1月至2016年12月,采用可吸收线网兜样编织结合张力带钢丝治疗髌骨下极粉碎性骨折80例,其中男45例,女35例;年龄25～60(45.0±2.0)岁,所有骨折为新鲜闭合性骨折。术后6周采用疼痛视觉模拟评分(VAS)、膝关节屈伸活动范围评估手术预后,术后12个月采用膝关节HSS评分进行疗效评价。结果:患者手术时间(50.2±10.1) min,出血量(20.3±5.2) ml。术后40例患者获得随访,时间12～24(16.0±0.5)个月。术后6周VAS评分为1.8±0.4,膝关节屈伸活动范围为(120.6±1.5)°。所有骨折获得骨性愈合,时间(3.0±0.8)个月。术后12个月膝关节HSS评分95.6±0.6。结论:可吸收线网兜样编织结合张力带钢丝固定治疗髌骨下极粉碎性骨折具有操作简单、固定可靠、能够恢复髌骨解剖形态,可早期功能锻炼达到快速康复,愈后效果良好等优点,是治疗髌骨下极粉碎性骨折的理想方法之一。     

双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折

目的：探讨双滑轮结合缝线桥技术治疗髌骨下极粉碎性骨折的临床疗效。方法 ：2018年1月至2020年6月采用双滑轮结合缝线桥技术治疗15例髌骨下极粉碎性骨折患者,其中男9例,女6例,年龄28～68(42.4±9.6)岁。患者伤后均有明显膝关节疼痛及活动受限,均行膝关节X线和CT检查,明确为髌骨下极粉碎性骨折。术后定期拍摄膝关节X线片了解骨折愈合情况并测量Insall-Salvati指数,记录关节活动度,并采用Bostman评分系统评价术后膝关节功能。结果：15例患者均获得随访,随访时间7～24(11.4±4.2)个月,无明显膝前痛病例。末次随访时患肢膝关节活动度为105°～140°（128.5±12.8）°,Insall-Salvati指数为0.79～1.12 (0.92±0.18)。X线片提示髌骨均骨性愈合,未见锚钉脱落、断裂及骨折块移位等情况。Bostman髌骨骨折功能评分（27.85±2.06）分,优13例,良2例。结论：双滑轮技术结合缝线桥技术治疗髌骨下极粉碎性骨折复位固定可靠,术后患者可早期开始功能锻炼。     

Outcome of low profile mesh plate in management of comminuted displaced fracture patella

PurposeTo assess the clinical results of using mesh plate in management of displaced comminuted fracture patella.Patients and methodsBetween January 2014 and October 2015, nine patients with closed displaced comminuted fracture patella were fixed using mesh plate and 2 mm mini screws.ResultsAll fractures united after an average of 10 weeks. At final follow-up of an average 19.6 months, average postoperative Lysholm score was 89.1 ± 4.9, and average Postoperative Böstman scale was 27.2 ± 3.1. No hardware related complications were recorded.ConclusionLow profile mesh plate is a good option in management of comminuted fracture patella with good clinical outcome. This new surgical technique may be particularly useful in comminuted fractures when patellectomy would otherwise be considered.     

Injuries to the distal femur and patella

Injuries around the knee are often high-energy injuries. The anatomy of the distal femoral physis contributes to its stability and hence high energy is required for disruption of this physis. As the distal femur contributes to the majority of the growth of the lower limb, injury to this growth plate has a high incidence of growth disturbance. Supracondylar femoral fractures can be difficult to reduce and fix due to the short metaphyseal segment. Patellar dislocations are commonly seen in adolescents. Patellar fractures are the result of direct or indirect trauma in children. These can be associated with osteochondral fragments and sleeve fractures often seen in children. Mechanisms of injury, associated anatomy and management options for distal femoral fractures, distal femoral physeal injuries and patella injuries are discussed in this article.     

Comminuted displaced fractures of the patella

A series of 64 comminuted displaced fractures of the patella is reviewed. Morphologically the fractures can be classified into three groups reflecting the mechanism of injury and the degree of soft tissue damage. All fractures were operated on. Tension band wire was used in 21, partial patellectomy in 33 and total patellectomy in 10 patients.The problem of the management of these fractures is often in making the choice between excision and internal fixation. In this retrospective analysis the results of anterior tension band wire fixation were acceptable even in severe comminuted fractures. Partial excision showed satisfactory results provided that at least three-fifths of the patella could be preserved. Total excision is sometimes clearly unavoidable but should be preceded by sober contemplation whenever considered as the alternative to internal fixation.     

A novel technique of patella fracture fixation facilitating early mobilization and reducing re-operation rates

Objective

Fractures of patella constitute 1% of all fractures. Various techniques have been described for internal fixation of patella fractures. Superiority of one technique over the other has long been debated. We reviewed a series of fifty-one patients with transverse or comminuted fractures of patella treated with a novel technique to assess if it had any advantages over the existing methods of fixation.

Design

Retrospective.

Setting

A tertiary care centre.

Patients & methods

Fifty-one patients with patella fracture OTA 34C, with a mean age of 39 years (range 18–61) were treated with technique of cerclage and two tension bands at our institute. Forty-eight patients completed the study.

Main outcome measurements

Range of Motion and evidence of radiological union were assessed at regular follow-ups.

Results

Forty-four out of forty-eight patients had gained up-to 90 degrees of active flexion at the end of 1 week. Two patients (4.2%) developed superficial infection. All fractures had united at the end of 12 weeks. Five patients (10.3%) underwent a second surgery; four (8.3%) due to implant related complications. Malunion or non-union was not noted in any of the cases.

Conclusion

The advantages of the described method are early mobilization, elimination of k-wire related complications, and ease of use in comminuted fracture pattern as well and a lower reoperation rates as compared to the available literature. We strongly recommend its use in cases of displaced comminuted/transverse fractures of patella as an alternate method of treatment.

Level of evidence

Level III.     

髌胫预压聚髌器固定治疗陈旧性分离髌骨骨折

目的探讨髌胫预压聚髌器固定治疗陈旧性分离髌骨骨折的疗效。方法对18例陈旧性分离髌骨骨折患者术前先行髌骨、胫骨结节间弹性持续加压,待骨折块靠近后切开复位,用聚髌器固定。结果 18例全部获得随访,时间7~48个月。骨折均一期愈合,髌骨的解剖结构得到重建。根据王亦璁改良膝关节功能评分法:优10例,良6例,可2例。结论陈旧性分离髌骨骨折行髌胫预压聚髌器固定治疗方便易行,牵引力线合理,便于护理,聚髌器固定牢靠,更适宜配合术前、术后CPM锻炼,功能恢复满意。