髌骨骨折不同治疗方法的临床疗效比较及治疗策略分析

目的:比较克氏针张力带、空心螺钉张力带和髌骨爪治疗髌骨骨折的疗效,为临床选择恰当的治疗方式提供依据.方法:对2002年1月至2009年1月在我科进行治疗的302例髌骨骨折患者进行回顾分析,其中143例应用改良克氏针张力带内固定治疗(KW组),72例采用空心螺钉钢丝张力带法内固定治疗(HW组),87例应用髌骨爪内固定治疗(PC组).并从手术时间、骨折愈合时间、并发症发生率、治疗费用和关节功能评价等方面进行比较分析.结果:3组病例均获随访6个月以上,对于单纯横行骨折,3组病例在手术时间、骨折愈合时间、术后疗效评定、术后并发症发生率均无统计学差异(P＞0.05)；在粉碎性骨折的治疗中,手术时间和骨折愈合时间差异不明显(P＞0.05),但在术后疗效评定上,PC组与其他两组差异显著(P＜0.01),其优良率达100％,KW组为78.9％,HW组为80.6％.另PC组的术后并发症发生率低于其他两组(P＜0.01),为5.0％,KW组为25.8％,HW组为15.7％.3组病例的治疗费用差异也较明显(P＜0.01),PC组高达(8 631±115)元,其次为HW组(4 106±103)元,KW组的治疗费用最低,只有(2725±127)元.结论:克氏针张力带在单纯横行骨折手术疗效可靠、而且明显减低医疗消耗,是一种非常有效的治疗方法,应作为髌骨骨折常规手术方式选择.对于复杂粉碎性骨折,髌骨爪具有固定可靠、疗效显著的优点,应受到临床医生的重视.     

改良AO张力带钢丝内固定治疗髌骨骨折

目的：探讨改良AO张力带钢丝内固定治疗髌骨骨折的优缺点。方法：回顾性分析我院30例髌骨骨折采用改良AO张力带钢丝内固定的治疗效果。结果：经6～12个月随访30例患者骨折均愈合，其中优20例，良6例，可3例，差1例。结论：改良AO张力带钢丝内固定治疗髌骨骨折疗效可靠，手术方法简单，其成本低于镍钛记忆合金聚髌器；固定强度明显优于环行钢丝，但不如松质骨螺钉和空心钉 张力带方法，适合用于髌骨横行骨折和不太严重的粉碎性骨折。     

记忆合金髌骨爪与张力带钢丝治疗髌骨骨折的临床疗效对比

目的探讨记忆合金髌骨爪与张力带钢丝在治疗髌骨骨折中的疗效差异。方法 98例髌骨骨折患者,其中采用记忆合金髌骨爪内固定治疗48例(记忆合金髌骨爪组),采用张力带钢丝治疗50例(张力带钢丝组)。所有病例随访3～14个月,平均9个月。比较两组的手术时间、膝关节功能恢复的优良率及相关并发症的情况。结果术后膝关节功能恢复情况比较,记忆合金髌骨爪组优良率97.9%,张力带钢丝组优良率86%,差异有统计学意义(P<0.05);两组手术时间比较,差异有统计学意义(P<0.05);术后并发症中内固定滑脱松动、内固定物皮肤刺激两项记忆合金髌骨爪组明显少于张力带钢丝组,差异有统计学意义(P<0.05)。结论记忆合金髌骨爪治疗髌骨骨折疗效优于改良张力带钢丝,是一种优良的内固定方法。     

克氏针张力带与分体式髌骨爪内固定治疗髌骨粉碎性骨折64例

采用克氏针加张力带钢丝内固定治疗髌骨粉碎骨折30例,分体式髌骨爪内固定髌骨粉碎性骨折34例。64例患者均获随访,随访时间3～24(平均18)个月,骨折均愈合,并分别进行膝关节功能疗效评定比较,两者间差异有统计学意义(χ2=4.338,P<0.05)。分体式髌骨爪内固定治疗粉碎性髌骨骨折,具有固定牢固,术后可早期活动,康复快、疗效确切。     

髌骨体部横行骨折空心钛钉结合张力带钢丝的治疗体会

目的：探讨空心拉力螺钉张力带钢丝内固定方法治疗髌骨骨折的手术适应证及其优、缺点。方法：回顾性分析28例髌骨骨折患者,其中18例髌骨横行骨折患者采用AO空心钉加张力带钢丝内固定治疗。结果：经6个月~2年随访,18例患者骨折均愈合,其中：优13例,良4例,可1例。结论：空心拉力螺钉张力带钢丝内固定治疗髌骨骨折疗效可靠,固定牢靠;其成本低于镍钛记忆合金聚髌器,但高于克氏针张力带钢丝;固定强度在所有方法中最强,故膝关节可以早期进行功能恢复,临床愈合时间短。但因2枚空心钉吃骨量大,不适合于严重粉碎性髌骨骨折,其最佳手术适应证为髌骨横行骨折。     

髌骨针与可吸收钉内固定治疗髌骨骨折的疗效比较

目的:比较髌骨针与可吸收钉内固定治疗髌骨骨折的临床疗效。方法:80例髌骨骨折患者随机分为髌骨针治疗组和可吸收钉治疗组各40例。观察两组骨折愈合时间及疗效,记录屈膝90°时间、膝关节功能恢复时间。结果:80例均获得随访,骨折均获得骨性愈合。髌骨针组优良率97.5%;可吸收钉组优良率95.0%。两种方法在骨折愈合时间及疗效方面无明显差别(P>0.05),但在屈膝达90°时间、膝关节功能恢复时间方面差异有统计学意义(P<0.05)。结论:两种方法治疗髌骨骨折均可获得骨性愈合,达到良好的临床疗效。与可吸收钉相比,髌骨针符合张力带原则,具有较好的生物力学稳定性,固定牢靠,有利于早期功能锻炼和膝关节功能的恢复。     

改良针尾带孔可折断式髌骨针内固定治疗尺骨鹰嘴骨折的临床观察

目的比较改良针尾带孔可折断式髌骨针张力带钢丝与传统克氏针张力带钢丝内固定治疗尺骨鹰嘴骨折的临床疗效。方法将2010-02—2015-01收治的52例尺骨鹰嘴骨折患者随机分成两组,每组26例,A组:采取改良针尾带孔可折断式髌骨针张力带钢丝内固定;B组:采用传统克氏针张力带钢丝内固定。通过对手术时间、术后骨折愈合时间及肘关节功能恢复几方面对比两组临床疗效。结果手术时间:A组明显少于B组(P0.05),差异有统计学意义。A、B组两组骨折愈合时间及功能评分比较(P0.05),差异无统计学意义。A组未发生内固定松动,B组发生5例。结论改良针尾带孔可折断式髌骨针张力带钢丝内固定治疗尺骨鹰嘴骨折操作方便,可有效缩短手术时间,避免内固定松动,有利于肘关节功能的早期恢复。     

髌骨爪结合有限内固定治疗粉碎性髌骨骨折

目的探讨髌骨爪结合有限内固定治疗髌骨粉碎性骨折的临床疗效。方法采用分体式髌骨爪加克氏针、钢丝内固定治疗粉碎性髌骨骨折36例,根据髌骨骨折分型：本组均为粉碎性骨折,且有分离移位。结果 36例均获随访,随访时间6～36个月,平均15个月,骨折均愈合。按陆裕朴等膝关节功能评定法进行评定。优33例,良2例,可1例。结论髌骨爪结合有限克氏针内固定治疗粉碎性髌骨骨折,具有固定牢固,术后可早期活动,康复快、疗效确切。     

空心拉力螺钉钢丝张力带固定治疗髌骨骨折的疗效

目的探讨空心拉力螺钉钢丝张力带固定治疗髌骨骨折的疗效。方法采用空心拉力螺钉钢丝张力带固定治疗髌骨骨折患者32例,其中闭合性骨折27例,开放性骨折5例。所有的骨折均用AO 3.5mm直径的中空拉力螺钉和8号软钢丝,随访12个月。通过膝关节的临床检查、关节活动度、X线片来评价关节功能。结果术后随访12个月,全部患者均获得临床愈合,其中优28例,良4例。骨折临床愈合时间为8～12周。结论应用空心拉力螺钉钢丝张力带固定治疗髌骨骨折,临床效果满意,提高了固定的牢固性和稳定性,避免传统张力带固定的并发症。但因2枚空心钉吃骨量大,不适合于严重粉碎性髌骨骨折,其最佳手术适应证为髌骨横行骨折。     

Cable-Pin系统与克氏针张力带内固定手术治疗髌骨横行骨折的对比观察

目的对比并观察Cable-Pin系统与克氏针张力带内固定手术治疗髌骨横行骨折的临床疗效。方法纳入2012年10月至2015年9月确诊为髌骨横行骨折的70例患者,随机分为两组,35例患者接受切开复位Cable-Pin系统内固定治疗(Cable-Pin组),35例患者接受切开复位克氏针张力带内固定治疗(克氏针组)。随访时间为术后12个月,随访内容包括骨折愈合时间、HSS(特种外科医院)膝关节功能评分以及并发症发生情况。结果 Cable-Pin组和克氏针组相比,在骨折愈合时间上无统计学差异(P0.05);治疗后3~12个月,Cable-Pin组的HSS评分高于克氏针组,差异有统计学意义(P0.05)。此外Cable-Pin组患者的术后并发症发生率要远低于克氏针组,差异有显著性(P0.05)。结论 Cable-Pin系统治疗横行髌骨骨折牢固可靠,术后HSS评分更高,并发症发生率更低,膝关节功能恢复更好,其修复效果优于克氏针张力带治疗。     

Treatment of comminuted patellar fracture with the nitinol patellar concentrator

Aim To evaluate the clinical effect of the nitinol (NiTi)-patellar concentrator (NT-PC) for the treatment of comminuted patellar fractures. Material and methods A total of 32 patients with acute comminuted patellar fracture accepted open reduction and internal fixation with the NT-PC, and the curative effects were evaluated using the Böstman clinical grading scale. Results All fractures were anatomically reduced by surgery and all cases were followed-up for six to 18 months. The mean score of patients according to the Böstman clinical grading scale was 25.6, with 29 of 32 (90.7%) patients achieving excellent or good results. Two patients had traumatic arthritis, one had slippage of the NT-PC, and all patients received pharmacotherapy. Conclusions The application of the NT-PC is a satisfactory approach to the treatment of comminuted patellar fractures.     

记忆聚髌器治疗髌骨骨折42例

选择1994-08/2004-02南宁市第一人民医院骨科采用钛镍记忆合金聚髌器治疗髌骨骨折42例,无一例感染及过敏反应,全部达到骨性愈合,无钛镍聚髌器脱落现象。疗效评估：优37例、良3例、差2例;26例粉碎性骨折疗效评估：优25例、良1例。提示钛镍记忆合金聚髌器是治疗髌骨骨折的良好内置物,并应作为粉碎性髌骨骨折的首选内置物。     

髌骨周围去神经化对保留髌骨的全膝关节置换术术后影响的Meta分析

目的探讨行保留髌骨的全膝关节置换术(TKA)中行髌骨周围去神经化对术后膝前痛的发生率及关节功能的影响。方法计算机检索Pub Med、Embase、Cochrane图书馆、中国知网(CNKI)数据库,收集行保留髌骨的TKA的临床随机对照研究(RCT),试验组行髌骨周围去神经化,对照组未行髌骨周围去神经化,提取纳入研究的基本资料,对其进行质量评价分析,采用Revman 5.0软件对纳入研究进行Meta分析。结果共纳入7个研究,862例患者,其中试验组433例,对照组429例。分析表明髌骨周围去神经化减少保留髌骨的TKA术患者术后膝前痛的发生率(P<0.000 1)。然而WOMAC评分、关节活动度、KSS评分系统的膝评分、Feller髌骨评分两组相比没有统计学差异(P=0.33;P=0.06;P=0.12;P=0.77)。结论保留髌骨的TKA行髌骨周围去神经化减低膝前痛的发生,对关节功能并没有明显影响。     

Traumatic patellar tendinopathy

Purpose. In patellar tendinopathy, there is anterior knee pain with tenderness of the attachment of the patellar tendon over the lower pole of the patella. The condition is commonly associated with athletic overuse, but we have encountered it in some patients following direct blunt trauma to the anterior aspect of the knee. We describe the history and management of patients with traumatic patellar tendinopathy.

Method. Between April 2000 and August 2006, we managed eight otherwise healthy well trained athletes who developed signs and symptoms compatible with classical patellar tendinopathy after a direct trauma to the anterior aspect of the patellar tendon during sport activity.

Results. The clinical diagnosis of patellar tendinopathy was confirmed clinically and at imaging by MRI and ultrasound scans. Patients responded to conservative or surgical management, in the same way as patellar tendinopathy secondary to overuse.

Conclusion. A single direct traumatic event can lead to chronic tendon problems. Hence, in addition to overuse injury, patellar tendinopathy can follow a direct trauma and exhibit the same clinical features. Further research is required to better understand the pathophysiology of the clinical condition.     

人工胶及髌骨爪记忆合金治疗髌骨粉碎性骨折的疗效评价

目的评价髌骨粉碎性骨折的人工胶辅助复位及髌骨爪记忆合金固定的治疗效果。方法2003年1月至2005年1月我院收治髌骨粉碎性骨折病人36例,其中男性20例,女性16例;平均年龄45.2岁;髌骨体粉碎19例,下极粉碎17例。术中人工胶辅助复位及Ti-Ni髌骨爪记忆合金固定。手术前、后X线片对比,评价复位及愈合情况。随访6～18个月,平均15个月。结果术后关节面平整,基本解剖复位。关节面术前分离移位2.89±1.59cm,术后0.017±0.04cm,手术前后有显著性差异。术后关节面台阶0.1±0.19mm。骨折6～8周全部愈合。术后6周膝关节屈曲平均105°。术后随访未出现内固定失败、创伤性关节炎病例,1例伤口愈合不良。陆裕朴膝关节功能标准评定,优18例,良17例,中1例,优良率97.2%。结论髌骨粉碎性骨折的手术切开,人工胶辅助复位效果良好,髌骨爪记忆合金固定牢固,符合生物力学原则,功能恢复满意,并发症少,适合临床应用。     

髌骨骨折的再手术

目的:分析髌骨骨折术后再手术的原因,并探讨其治疗方法。方法:对14例再手术的髌骨骨折患者的资料 进行回顾分析,并进行再次手术治疗,均采用"8"字改良张力带环扎钢丝固定。结果:随访3~12个月,按陆氏评定标准评 定,优7例,良4例,可3例。结论:治疗髌骨骨折必须根据骨折类型选择合适的固定方法,依照固定的稳定性指导病人做 适度的功能锻炼,防止骨折的再移位。"8"字改良张力带加环扎钢丝固定是髌骨骨折再手术的首选固定方法。     

Patellar tendonitis and patellar dislocations

Common sports injuries, such as patellar tendonitis and patellar dislocation, can be treated either surgically or with rehabilitation and physical therapy. Most patients with patellar tendonitis will respond well to conservative measures; however, some recalcitrant cases will require surgical intervention. To date, the literature is not able objectively to identify the patients best suited to surgery. Likewise, in the case of patellar dislocations, it is still unclear which patients respond best to conservative therapy and which respond best to surgical treatment, although evidence continues to accumulate. A practical approach to this problem can be deduced from the available evidence, but more well-designed clinical trials are needed for the establishment of definitive treatment protocols.     

关节镜下髌骨支持带调整术治疗青少年 复发性髌骨脱位的近期疗效

目的探讨关节镜下髌骨内外侧支持带调整术治疗青少年复发性髌骨脱位的近期临床疗效。方法对2002年6月~2009年8月收治的25例青少年复发性髌骨脱位患者进行回顾性分析,其中21例22膝获完整随访。左膝12侧,右膝10侧。患者既往髌骨脱位2~6次。首次脱位至手术时间3~116个月,平均28.5个月。所有患者术前均有不同程度的膝关节疼痛和剧烈活动时不稳感,髌骨外推恐惧试验均为阳性,4例磨髌试验阳性,5例伸膝抗阻痛阳性。术前常规行膝关节正侧位和髌骨轴位X光片检查,记录术前Q角(14.3±2.7)°,术前患侧大腿较健侧萎缩(2.2±0.83)cm。患者术前国际膝关节评分委员会(IKDC)评分(44.3±3.3)分、Lysholm评分(55.7±3.7)分。所有患者均于关节镜下行髌骨外侧支持带松解、内侧支持带缝合紧缩术治疗,术后行正规功能康复。结果 21例22膝获随访,随访时间24~54个月,平均32个月。术后患膝活动良好,随访期未见脱位及患膝发育异常。术后24个月观察,髌骨外推恐惧试验阳性3例;Q角(15.4±2.5)°,与术前比较差异有显著性(P=0.0142);患侧大腿较对侧萎缩(1.2±0.43)cm,与术前比较差异有显著性(P=0.0224);IKDC评分(72.5±4.1)分、Lysholm评分(77.3±3.5)分,均较术前显著提高(P=0.0072,P=0.0023)。结论关节镜下髌骨支持带调整术治疗无严重膝关节发育异常的青少年复发性髌骨脱位近期疗效满意。     

Intertester reliability of sonography in patellar tendinopathy.

OBJECTIVE: Intertester reliability is imperative during the sonographic assessment of patellar tendinopathy because hypoechoic areas can change over time, and repeated examination may involve multiple examiners. Given that, to our knowledge, it has not been reported in the literature, the objective of this study was to investigate the intertester reliability of sonography for the detection and measurement of hypoechoic areas associated with patellar tendinopathy. METHODS: The study cohort comprised 8 patients with clinically diagnosed patellar tendinopathy and 4 patients with bilateral asymptomatic patellar tendons. Two equally experienced musculoskeletal radiologists imaged both patellar tendons from each patient (n = 24). All 24 tendons were assessed on the same day with the use of identical sonography machines. RESULTS: The radiologists had 100% chance-corrected agreement for detecting 12 normal (hypoechoic free) and 12 abnormal (hypoechoic) tendons. All measurement data were normally distributed (P > .05), and a range of hypoechoic area sizes was evident. No statistically significant differences were found for the measurements of hypoechoic area, axial plane height and width, and sagittal plane height (P > .05). In addition, these measurements were equally highly correlated (Pearson r > 0.87; P < .01). CONDUSIONS: The results reported in this study suggest that the intertester reliability of sonography for the assessment of patellar tendinopathy is high. Although these results are encouraging, a small sample was analyzed, and this increases the probability of type II measurement error. Larger studies are therefore required to confirm these findings. High intertester reliability indicates that multiple experienced radiologists can reliably assess the same tendon and provides researchers with a necessary foundation for furthering research in tendon rehabilitation.