Cable—Pin系统选择性治疗髌骨骨折的疗效分析

[目的] 探讨应用Cable-Pin系统内固定治疗髌骨骨折的临床疗效.[方法] 2005年10月～2007年5月,利用Cable-Pin系统选择性治疗髌骨骨折35例,均为闭合性髌骨骨折患者,其中横行骨折19例,粉碎性骨折16例,男21例,女14例;年龄21～75岁.切开复位后,垂直骨折线或主要骨折块选择适当长度2根半螺纹拉力螺钉用动力系统攻钻入骨,然后在髌骨远端(或近端)横行钻一骨隧道,用钢缆穿过隧道,在髌骨前方"8"字结扎,用专用器械收紧钢缆,以专用束缚器将钢缆固定,16例粉碎性髌骨骨折,全部于髌骨外侧环扎.[结果] 本组35例患者随访12～18个月,平均13.2个月.伤口均Ⅰ期愈合,无感染发生.骨折全部愈合.无退钉、钢缆松脱和皮肤刺激等并发症发生.以Bostman髌骨骨折疗效评分标准进行评分:优32例,良3例,优良率为100%.[结论] Cable-Pin系统对骨折固定牢固可靠,术后并发症发生率低,是治疗髌骨骨折的一种新方法.     

Cable-Pin系统选择性治疗髌骨骨折

目的探讨Cable-Pin系统内固定治疗髌骨骨折的方法和疗效。方法 16例患者,均为闭合性髌骨骨折,其中横形13例,粉碎性3例;男11例,女5例;年龄20～68岁,平均49岁。采用Cable-Pin系统选择性治疗,切开复位后,垂直于骨折线或主要骨折块选择适当长度2根半螺纹拉力螺钉用动力系统攻钻入骨,然后在髌骨一端横行钻一骨道,用钢缆穿过骨道,在髌骨前方＂8＂字结扎,用专用器械收紧钢缆并束缚固定,如骨折仍欠稳定可再加环扎固定。结果 16例患者均获随访,随访时间11～18个月,平均14.5个月。切口均期愈合,骨折全部愈合,平均8～12个周,无感染,无钢缆松脱、滑移、断裂,退钉和皮肤刺激等并发症发生。采用Bostman髌骨骨折疗效评分标准进行评分：优15例,良1例,优良率为100%。结论 Cable-Pin系统对有适应证髌骨骨折固定牢固可靠,并发症发生率低,膝关节功能恢复良好。     

Cable-Pin系统在尺骨鹰嘴骨折治疗中的应用

目的观察分析Cable-Pin系统在治疗尺骨鹰嘴骨折中的疗效。方法应用Cable-Pin系统作为张力带固定治疗尺骨鹰嘴骨折14例,均为横断型的尺骨鹰嘴骨折。结果 14例获得6～18个月随访,平均10个月。骨折全部愈合,无退钉、钢缆松动断裂等并发症发生。采用Broberg-Morrey功能评分标准对肘关节功能进行评分:优11例,良3例。结论Cable-Pin系统对尺骨鹰嘴骨折固定可靠,并发症少,是治疗横断型尺骨鹰嘴骨折较理想的新选择。     

钢缆螺钉及钢缆针在髌骨骨折中的临床应用

目的探讨钢缆螺钉及钢缆针治疗髌骨骨折的临床效果。方法对32例髌骨骨折患者应用钢缆螺钉及钢缆针治疗。结果 32例均获得随访,时间4个月～2年。患者切口均一期愈合。骨折均愈合,愈合时间为8～12周。无骨折块移位、内固定松动或断裂出现,无钢缆或克氏针突出于皮下刺激皮肤等并发症发生。按Bostman标准评定疗效:优秀23例,良好9例。结论钢缆螺钉及钢缆针治疗髌骨骨折符合生物力学内固定的原则,操作简便,固定牢靠,可早期膝关节功能锻练,适应范围广,并发症少,临床疗效满意。     

分体组合式髌骨爪结合钢丝环扎内固定治疗髌骨骨折

目的探讨分体组合式髌骨爪结合钢丝环扎内固定治疗髌骨骨折的方法与临床效果。方法2009年5月到2011年9月．本院通过运用分体组合式髌骨爪结合钢丝环扎内固定治疗28例髌骨骨折。术后随访观察骨折愈合情况及膝关节功能恢复情况。结果28例患者均得到随访,时间9～16个月,平均11个月。骨折均达到解剖复位并骨性愈合,愈合时间为9～12周。功能评价：优26例,良1例．可1例,优良率96．4％。结论采用分体组合式髌骨爪结合钢丝环扎内固定治疗髌骨骨折能够达到骨折的坚强固定、操作简单易行,并发症少,膝关节功能优良率高。     

微创张力带固定治疗横断型髌骨骨折

目的探讨微创张力带固定治疗横断型髌骨骨折的适应征和临床效果。方法回顾性分析1997年6月～2005年6月间应用微创张力带法治疗横断型髌骨骨折(闭合性或污染较轻的开放性骨折)38例,其中经皮穿刺克氏针钢丝张力带固定26例,经皮穿刺空心钉张力带固定12例。对骨折复位程度、关节活动度及膝关节功能进行分析。结果所有手术操作顺利。所有患者获6个月～6．5年(平均32个月)的随访。骨折愈合时间6～12周,平均7．7周；无内固定失败及创伤性关节炎等并发症发生。临床效果评定采用胥少汀式髌骨张力带固定术后评价标准,骨折复位程度：优21例,良11例,中6例,优良率为84．2%。全部病例膝关节活动度均在正常范围内,膝关节功能评价均为优良,其中优34例,良4例。结论微创张力带固定治疗横断型髌骨骨折临床效果优良。该技术主要适用于闭合性横断型髌骨骨折和创口较小且污染较轻的髌骨骨折,对于骨折块不超过3个且位置尚可的粉碎骨折也可酌情使用。     

髌骨环置入内固定治疗37例38侧髌骨骨折初步随访报告

[目的]评价采用髌骨环置入内固定治疗髌骨骨折的效果.[方法]37例(38侧)髌骨骨折(其中横断骨折18例、粉碎性骨折20例),均作骨折切开复位髌骨环置入内固定.术后早期被动及主动康复训练.[结果]37例患者中,35例36侧获得随访,随访时间为6～24个月,平均13个月.患者膝关节功能根据Bostman~([1])髌骨骨折疗效临床评分标准:优32侧,良4侧,一般2侧,差0侧;优良率94.4%.[结论]髌骨环置入内固定治疗髌骨骨折,固定可靠安全,疗效满意.     

五角网缝合术治疗髌骨骨折

目的:探讨一种操作简单、疗效可靠的治疗髌骨骨折手术方式。方法:髌骨骨折患者56例,男40例,女16例;年龄18～82岁。右侧骨折33例,左侧23例。横断骨折28例,粉碎骨折24例,撕脱型骨折4例。伤后至手术时间3h～7d。术中显露髌骨,复位,巾钳临时固定,采用双股可吸收缝线编织一个五角星,呈网状置于髌骨前,用丝线穿过五角星之5个角,做双半环髌骨周围缝合,固定髌骨。结果:56例髌骨骨折术后随访6～45个月,平均16.2个月,骨折均愈合。按Bostman髌骨骨折疗效评价标准,优秀45例,良好11例。结论:五角网缝合术治疗髌骨骨折,具有操作简单、固定牢固、术后可早期活动、康复快、疗效确切、无须二次手术取内固定等优点。     

镍钛聚髌器联合钢缆内固定治疗髌骨粉碎性骨折

目的探讨镍钛聚髌器联合钢缆内固定治疗髌骨粉碎性骨折的疗效。方法 45例髌骨骨折采用膝正中直切口、镍钛聚髌器联合钢缆内固定治疗。结果 45例均获12～24个月随访,平均13.6个月。骨折均愈合,无聚髌器、钢缆松脱,无切口感染及皮肤刺激。疗效按Bostman膝关节功能评分标准:优35例,良8例,可2例,优良率95.6%。结论镍钛聚髌器联合钢缆内固定治疗髌骨粉碎性骨折具有操作简便、内固定牢靠、无需外固定、可早期行功能锻炼及术后并发症少等优点。     

应用Cable—needle钢缆环扎治疗粉碎性髌骨骨折

目的探讨Cable—needle钢缆环扎治疗粉碎性髌骨骨折的临床疗效。方法回顾分析2010年1月至2012年3月我科收治的25例病例,均为粉碎性髌骨骨折,男18例,女7例;年龄15～65岁,平均39岁。采用Cable—needle钢缆进行治疗。结果全部病例随访3～25个月,平均10个月。手术切口一期愈合,未发生感染,骨折全部愈合,无Cableneedle钢缆松动并发症,仅1例髌骨骨折术后3个月Cable—needle钢缆卡扣处钢缆残端外露,突破皮肤,给予取出钢缆闭合皮肤破口,顺利愈合。参照bostman髌骨骨折疗效评分标准进行评分,优23例,良2例,优良率100％。结论Cable—needle钢缆环扎治疗粉碎性髌骨骨折,骨折固定牢固,操作简便,对于粉碎性髌骨骨折是一种较好的选择。     

穿骨道线缆结合带尾孔克氏针治疗髌骨骨折

目的:探讨应用穿骨道线缆结合带尾孔克氏针治疗髌骨骨折的临床疗效.方法:自2012年5月至2013年7月,采用穿骨道线缆结合带尾孔克氏针内固定治疗34例髌骨骨折患者,均为闭合性骨折,其中男18例,女16例;年龄26～81岁,平均(46.0±3.0)岁;横形骨折12例,粉碎性骨折22例.观察患者的手术时间、术中出血量、术后膝关节首次锻炼时间及术后并发症情况,术后根据B(o)stman髌骨骨折疗效评分标准对其功能进行评价.结果:所有患者获得随访,时间12～26个月,平均(16.0±2.0)个月.所有患者伤口甲级愈合,骨折全部愈合.手术时间(54.2±10.4) min,术中出血量(56.0±8.5)ml,术后膝关节首次锻炼时间(4.6±1.3)d.术后无感染、退针、线缆松脱,无皮肤刺激等并发症发生.根据B(o)stman髌骨骨折疗效评分标准进行评价,总分29.06±1.67,其中优33例,良1例.结论:穿骨道线缆结合带尾孔克氏针系统内固定治疗髌骨骨折,特别是横形骨折,固定牢固可靠,可早期活动膝关节,并发症少.     

Netzwerkpartner Arbeitstherapeut im Rehabilitationsmanagement

Due to the functional importance of the patella, accurate reduction and rigid fixation of patellar fractures are required. Tension band wiring has long been the standard treatment of these fractures, but there are several problems associated with this technique, e.g. loosening of the wires, fracture dislocation and poor outcome. Another possibility in the treatment of transverse patellar fractures is screw fixation. Although this technique ensures stable osteosynthesis, anatomical reduction is often problematic, especially in comminuted fractures. A good option in the treatment of (comminuted) patellar fractures is the newly designed locking patella plate, which combines anatomical reduction and stable osteosynthesis. In biomechanical tests the plate provided a more stable fixation of the patellar fracture and showed higher mechanical strength compared to classic tension band wiring. The first clinical applications achieved optimal fracture reduction. No complications have occurred to date following the use of the plate. Thus the patella plate represents a good option in the treatment of patellar fractures.     

空心钉钛缆内固定治疗髌骨骨折

目的 探讨空心钉钛缆内固定治疗髌骨骨折的疗效.方法 2008年2月至2010年9月共收治27例髌骨骨折患者,男11例,女16例;年龄23～65岁,平均44.2岁.均为闭合性髌骨骨折.骨折按Rockwood分型:Ⅱ型11例,Ⅲ型9例,Ⅳ型5例,Ⅴ型2例.采用直切口复位骨折后略屈膝关节,用2枚1.25 mm导针经髌骨上极或下极平行钻入,钻孔后沿导针拧入4.0 mm半螺纹自攻空心螺钉,经空心钉穿入1.3 mm钛缆锁紧形成"8"宁张力带结构.术后早期开始功能锻炼.结果 27例患者术后获平均12个月(6～24个月)随访.随访6周时所有患者骨折均达到临床愈合标准,于平均2.6个月(2～3个月)获骨性愈合.膝关节屈曲0～130°.随访期间无钛缆松动、断裂、骨折分离、感染及排斥反应等并发症发生.按照Bostman髌骨骨折功能评定标准评定疗效:优24例,良3例,优良率为100%.结论空心钉钛缆内固定具有操作简便、固定牢靠、可以早期活动关节及疗效确切等优点,是一种治疗髌骨骨折的较好方法.

Abstract：

Objective To evaluate clinical effects of cannulated screws and a titanium cable in the treatment of patellar fractures. Methods From February 2008 to September 2010, 27 patients with patellar fracture were treated in our department. They were 11 males and 16 females, with an average age of 44. 2 years (from 23 to 65 years) . All cases were closed fracture without other injuries. According to the Rockwood s classification, 11 cases were Type Ⅱ, 9 Type Ⅲ, 5 Type Ⅳ and 2 Type Ⅴ. After open reduction, 2 guide pins (1. 25 mm) were drilled vertically through the patella in a superior or inferior direction to let half-threaded tapping cannulated screws go 4. 0 mm along the guide pin. A 1. 3 mm titanium cable traversed the cannulated screws and formed an 8-shaped tension band structure. All patients conducted knee joint isometric contraction one to 2 days after operation, did continuous passive motion (CPM) exercise after 3 days, walked with the brace after one week, did active flexion and extension training after 2 weeks, removed the brace protection after 3 weeks and conducted weight-bearing walking after 6 weeks. Results The 27 patients were followed up for an average of 12 months (from 6 to 24 months) . All patients achieved clinical healing after 6 weeks and bony consolidation after an average of 2. 6 months (2 to 3 months). The mean range of motion of the keen was 0 to 130°. Fractures healed without such complications as loosening of cable loop,screw breakage, soft tissue infection or rejection reaction. By the Bostman' s criteria, functional recovery was excellent in 24 cases and good in 3, with an excellent to good rate of 100%. Conclusion Treatment of patellar fractures with cannulated screws and a titanium cable is characterized by simple manipulation, reliable fixation, early rehabilitation and a high healing rate.     

空心螺钉钢丝张力带治疗髌骨骨折

目的 探讨空心螺钉钢丝张力带治疗髌骨骨折的临床效果. 方法 2006年1月至2007年4月,运用空心螺钉钢丝张力带技术治疗髌骨骨折36例.根据AO分型:A型6例,C型30例.其中女23例,男13例,年龄45～86岁,平均58岁.所有患者均为闭合性损伤,直接暴力12例,间接暴力24例.切开复位后屈曲膝关节,二根1mm导针经髌骨上极或下极平行钻入,然后选择4.0mm半螺纹自攻空心螺钉沿导针拧入,最后经空心钉以"8"字的方式穿入钢丝并拧紧完成张力带结构. 结果 36例患者均获平均8个月的随访,平均愈合时间6周.所有患者无伤口感染、内固定松动、软组织激惹等并发症.采用Bostman髌骨骨折疗效评分标准于术后6周进行功能评定:优32例,良4例,优良率100%. 结论 空心拉力螺钉结合钢丝张力带技术治疗髌骨骨折固定可靠,软组织激惹和复位丢失率低,是一种值得推荐的治疗手段.     

Adjustable patella grapple versus cannulated screw and cable technique for treatment of transverse patellar fractures

Background

Although the cannulated screw and cable (CSC) tension band technique is an effective method for fixation of transverse patellar fractures, it has shortcomings, such as extensive soft tissue damage, osseous substance damage, and complex manipulation. We conducted a retrospective comparison of the adjustable patella grapple (APG) technique and the CSC tension band technique.

Patients and methods

We retrospectively reviewed 78 patients with transverse patellar fractures (45 in the APG group and 33 in the CSC group). Follow-up was 18 months. Comparison criteria were operation time, fracture reduction, fracture healing time, the knee injury and osteoarthritis outcome score for knee function, and complications.

Results

The APG group showed shorter operation time and equal fracture reduction, fracture healing time, and knee function compared with the CSC group. Eleven patients in the APG group experienced skin irritation generated by implants. There was no complication in the CSC group.

Conclusions

The APG technique should be considered as an alternative method for treatment of transverse patellar fractures.     

经皮缝合治疗髌骨骨折

目的：探讨髌股固定缝合法治疗髌骨骨折的临床疗效。方法：采用克氏针经皮行髌骨上极与股骨髁部固定，再经皮穿针及经皮缝合固定骨折断端的方法治疗髌骨骨折23例，男17例，女6例；年龄18～73岁，平均32．4岁。采用Bostman临床评分标准对其疗效进行评定。结果：23例获得随访，时间6～38个月。平均11个月。所有骨折均达解剖或近解剖复位并骨性愈合，按Bostman疗效标准：优秀20例，良好3例。结论：采用髌股固定缝合治疗髌骨骨折，具有创伤小、并发症少、骨折对位准确、关节功能恢复好、无手术瘢痕影响美观等优点。     

Patellar fixation protected with a load-sharing cable: a mechanical and clinical study

The stability of patellar fracture fixation protected with a load-sharing cable was studied in cadavers. A transverse patellar osteotomy was produced and stabilized with standard patellar fixation with or without a figure-of-eight cable that extends from the proximal pole of the patella to the tibial tubercle. Standard fixation techniques (interfragmentary cancellous screws or modified tension-band wiring) alone failed after significantly fewer cycles of flexion and extension than did the same fixation when supplemented with a load-sharing cable. In the clinical evaluation of the load-sharing cable, 14 consecutive patients with displaced patellar fractures were treated. No immobilization was used and the patients were started on passive and active range of motion and weight-bearing ambulation in the early postoperative period. Thirteen fractures healed uneventfully. The increased stability of patellar fracture fixation protected with a load-sharing cable offers three advantages: (a) adjunctive casting is unnecessary, (b) comminuted fractures can be "pieced" together anatomically with less concern for loss of fixation, and (c) early postoperative passive and active range of motion can be achieved.     

Patellar Fracture After Total Knee Arthroplasty With Retention: A Retrospective Analysis of 2954 Consecutive Cases

BackgroundTo the best of our knowledge, there have been no large case studies on patellar fracture after total knee arthroplasty (TKA) with patella retention.MethodsFrom 2005 to 2019, 2954 consecutive TKAs with patella retention were retrospectively reviewed. The incidence of patellar fracture was confirmed. Perioperative demographic factors associated with patellar fracture were compared between the nonpatellar fracture control (randomly selected after age and sex matching) and patellar fracture patient groups. To confirm the prognosis of identified patellar fractures, Hospital for Special Surgery knee score, union rates, and complications after treatment were evaluated. Treatment outcomes were compared as per the treatment method, and fracture type was classified by shape.ResultsFor primary TKAs with patella retention, patellar fracture occurred in 32 of 2883 cases (incidence 1.11%). When comparing the preoperative demographic factors between the patellar fracture and control groups, there was a significant difference in knee flexion of the affected limb. Twenty-three cases were treated nonoperatively, and nine cases were treated operatively. Of the 32 patellar fractures, 28 had confirmed union, and the HSS score at the latest follow-up increased significantly from the preoperative score. The only complication noted after treatment was nonunion in three cases. We found no significant differences in treatment results as per the treatment method and fracture type.ConclusionPatellar fracture after TKA with retained patella is infrequent, with relatively improved clinicoradiological results over those of patellar fracture after TKA with resurfaced patella reported in the literature. The improved results did not differ as per the treatment method and fracture type.     

应用Cable-Pin内固定系统治疗尺骨鹰嘴骨折的病例对照研究

目的:通过与克氏针张力带(tension band wiring,TBW)比较明确应用CablePin系统治疗尺骨鹰嘴骨折的临床效果。方法:自2008年3月至2010年6月,65例尺骨鹰嘴骨折患者分为2组:CablePin组32例,男18例,女14例,年龄21～69岁,平均(53.69±13.42)岁,采用Cable-Pin系统内固定治疗;TBW组33例,男20例,女13例,年龄20～70岁,平均(53.18±13.36)岁,采用克氏针张力带治疗。记录2组手术时间、切口长度、术后血红蛋白含量、骨折愈合时间、手术并发症及肘关节功能HSS评分等,并进行统计学分析。结果:术后随访12～24个月,平均18.4个月。2组在骨折愈合时间(t=2.588,P=0.012),术后肘关节功能评分(Z=-2.039,P=0.041)和术后并发症发生方面差异有统计学意义,CablePin组优于TBW组。2组在手术切口长度、手术时间和术后血红蛋白含量方面差异无统计学意义。结论:CablePin系统内固定治疗尺骨鹰嘴骨折简便易行、疗效可靠、并发症少,优于克氏针张力带钢丝。