髌骨环固定器选择治疗髌骨粉碎性骨折

采用髌骨内固定治疗髌骨粉碎性骨折15例,均获得骨折愈合,膝关节功能恢复优良。髌骨环内固定是治疗髌骨粉碎性骨折的有效方法。     

钢丝荷包加张力带固定髌骨粉碎性骨折

目的：探讨髌骨粉碎骨折的固定。方法：对43例髌骨粉碎骨折，采用钢丝荷包加张力带固定，术后不予外固定，早期进行非负重功能锻炼。结果：经平均5年随访，按陆裕朴膝关节功能评定标准，43例术优33例，良6例，可3例，差1例，优良率90．7％。结论：钢丝荷包加力带固定髌骨粉碎性骨折，骨折复位满意：固定稳妥，下床时间早，愈后功能恢复功能理想。     

可吸收缝线垂直固定髌骨骨软骨骨折的治疗体会

对8例髌骨骨软骨骨折行切开复位可吸收缝线垂直固定,以Lysholm评分对膝关节功能进行评定。8例均获得随访12～38个月,Lysholm术前评分:25～60分,术后85～100分,术后Lysholm评分较术前明显提高。可吸收缝线垂直固定是治疗髌骨骨软骨骨折的一种较好方法。     

不同内固定方法治疗髌骨下极骨折临床效果观察

目的：观察不同内固定方法治疗髌骨下极骨折的疗效。方法随机将150例髌骨下极骨折患者分为三组,每组50例。按照内固定方法不同分为1组（钢丝环扎组）、2组（钢丝张力带组）、3组（钛缆内固定组）。比较三组疗效。结果三组手术时间、术中出血量比较差异无显著性意义（ P＞0．05）;术后随访1年,2、3组优良率明显优于1组（ P＞0．05）。结论钢丝张力带、钛缆内固定治疗髌骨下极骨折效果良好,同时能及时进行膝关节功能锻炼,值得推广应用。     

镍钛记忆合金聚髌器内固定治疗髌骨骨折的临床研究

目的：探讨镍钛记忆合金髌骨爪治疗髌骨骨折的临床应用与术后功能锻炼。方法：线性骨折采用复位钳复位髌骨,镍钛记忆合金髌骨爪髌骨内固定,粉碎性骨折先行可吸收缝合线环形荷包缝合固定髌骨后行髌骨爪髌骨内固定。结果：135例术后视骨折程度术后是否给予石膏托外固定,术后第2 d练习股四头肌锻炼,术后1周进行膝关节伸屈活动,术后2周扶拐下地行走。结论：镍钛记忆合金髌骨爪治疗髌骨骨折,周围组织刺激少、手术操作简单、骨折复位好、骨折愈合快、可早期恢复关节功能、避免髌骨切除,值得推广。     

老年髌骨粉碎性骨折的固定方法探讨

目的评价髌骨张力带内固定术、钢丝“8”字固定＋四周环抱术、部分切除术及改良式部分髌骨切除术治疗老年移位性髌骨骨折的疗效。方法59例老年移位性髌骨骨折，其中24例髌骨中部横断骨折，采用张力带内固定术：16例髌骨粉碎骨折采用钢丝“8”字固定＋四周环抱，5例髌骨下极骨折采用髌骨部分切除术；11例髌骨下极骨折和3例上极骨折采用改良式部分髌骨切除术。结果术后随访2-6年，按陆裕朴评定标准，张力带内固定术组：优18例，良3例，可3例；钢丝“8”字固定＋四周环抱术组：优12例，良1例，可3例；部分切除术组：可3例，差2例；改良式部分髌骨切除术组：优13例，良1例。结论张力带内固定术与钢丝“8”字固定＋四周环抱术是治疗老年移位性髌骨骨折的有效方法。治疗关键是解剖复位、稳妥固定及早期非负重功能锻炼。     

髌骨爪治疗髌骨骨折45例临床分析

应用髌骨爪治疗髌骨骨折45例,其中横断骨折30例,粉碎性骨折15例,采用切开复位内固定。所有骨折均Ⅰ期愈合,患者膝关节功能均为优良。     

直切口细克氏针加改良张力带治疗髌骨粉碎性骨折65例

目的探讨直切口细克氏针加改良张力带治疗髌骨粉碎性骨折的疗效。方法采用直切口细克氏针加改良张力带治疗65例髌骨粉碎性骨折患者。术后观察骨折愈合时间、X线片关节面平整程度、膝关节功能恢复情况。结果骨折愈合时间平均为85.5 d,X线片示关节面平整度良好,术后关节功能优良率93.8%。结论该术式手术适应证较广、创伤小、固定牢固、疗效确切,是治疗髌骨粉碎性骨折的有效方法。     

骨针钢缆内固定治疗髌骨下极骨折的膝关节功能观察

正髌骨下极骨折是临床髌骨骨折的特殊类型,需早期接受手术治疗以修复骨折端,恢复患者正常行走功能~([1])。髌骨下极在膝关节伸膝受力传导过程中发挥重要作用,故此类骨折手术方式的选择将直接决定患者远期下肢运动功能及患者的生活质量。骨针钢缆内固定、张力带内固定均是目前临床应用的髌骨骨折治疗手段,效果确切,笔者已作相应研究~([2-3]),但髌骨下极骨折由于骨折线位置的特殊性,骨块往     

髌骨冠状面伴横形骨折1例

髌骨冠状面骨折临床少见,诊断率不高,报道甚少,其受伤机制、分型、手术方式目前仍存在争议。现将笔者科室收治的1例髌骨冠状面伴横形骨折患者的临床资料报告如下。临床资料患者女性,66岁,因摔伤致右膝疼痛伴活动受限18h入院,行X线片检查示右髌骨骨折(图1a)。查体:右膝皮肤完整无破损,右髌骨处软组织稍肿胀,右髌骨前压痛明显,右膝屈伸功能因疼痛受限,右踝及右足各趾活动及肌力正常,右足背动脉搏动良好,右足各趾末梢感觉、皮温、血运良好。入院后诊断为右髌骨骨折,行CT示右髌骨中部横形骨折,近端骨折块可疑冠状面劈裂(图1a)。完善术前准备行右髌骨骨折切开复位内固定术,术中探查见髌骨中部横形骨折,骨折线外侧远端可见一2.0cm×1.5cm独立骨折块,可见髌骨远端骨折块呈冠状面劈裂,分为前后两层,可见髌骨近端骨折块完整,无冠状面劈裂,与术前CT示不一致(图1b)。用克氏针垂直于冠状面前后两层骨折块钻孔,用可吸收线(2-0 VICRYL)穿过孔道垂直套索固定远端冠状面劈裂骨折块,复位骨折端,3枚别针于髌软骨下纵向固定髌骨,予以2枚钛缆穿过别针行双“8”字固定(图1b)。探查见骨折对位对线良好,内固定牢固。术后复查X线片示髌骨骨折复位满意(图1c)。术后指导患者行股四头肌等长收缩及踝关节屈伸活动等功能锻炼,患者恢复满意出院。术后3个月复查见患者右膝功能恢复良好(图1d)。     

The inferomedial patellar protuberance and medial patellar ossicle in patellar instability

Purpose

The purpose of the study was to define the frequency of an inferomedial patellar protuberance in patients presenting to a specialist Patella Clinic and to characterise the clinical and radiological features as well the association between the inferomedial patellar protuberance and the medial patellar ossicle.

Methods

A cohort of 163 patients (166 knees) was reviewed from a prospectively collected clinical database and radiological imaging. This included a record of patellar tracking.

Results

An inferomedial patellar protuberance was found in 62 (37 %) knees. A medial patellar ossicle was noted in 56 (34 %) knees. In all, an inferomedial patellar protuberance or medial patellar ossicle or both was found in 90 (54 %) knees. The association between inferomedial patellar protuberance and significant trochlear dysplasia was highly significant (p = 0.01), but not for the medial patellar ossicle (n.s.). The presence of an inferomedial patellar protuberance was significantly less likely in patients with hypermobility syndrome (p = 0.001); however, there was no significant association between hypermobility syndrome and medial patellar ossicle (n.s.), or the presence of either or both an inferomedial patellar protuberance and medial patellar ossicle (n.s.). All patients with a clunk at 20°–30° flexion had significant trochlear dysplasia and an inferomedial patellar protuberance.

Conclusion

Radiological changes consistent with an inferomedial patellar protuberance were found in about one-third of patients presenting to a specialist Patella Clinic. Patellar maltracking and a clunk at 20°–30° flexion are associated with significant trochlear dysplasia plus an inferomedial patellar protuberance. If undertaking an operative correction, both deformities should be considered in order to avoid joint incongruity.

Level of evidence

III.

     

Adolescent patellar osteochondral fracture following patellar dislocation

Purpose

Patellar dislocations in adolescents may cause osteochondral fractures of the patella. The aim of this study was to review the outcomes of adolescent patients who underwent surgical intervention for patellar osteochondral fracture following patellar dislocation.

Methods

Nine patients who underwent surgery for osteochondral fracture of the patella following dislocation were identified retrospectively. Following arthroscopic examination, if the fragment was large enough to support fixation, headless screws or bioabsorbable pins were used. Otherwise, the loose body was excised, and the donor site was managed with a microfracture. Postoperatively, patients were assessed using the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) outcome measures.

Results

The average age of the patients was 14.6 with average follow-up 30.2 months. Four of the nine patients underwent fixation, while five patients underwent removal of loose body with microfracture. The average defect size in the nonfixation group was 1.2 cm² compared with 3.2 cm² in the fixation group. The IKDC scores for fixation and nonfixation groups were 63.9 (SD = 18) and 76.1 (SD = 11.7), respectively. The KOOS subscale scores for symptoms, function in sports and recreation, and knee-related quality of life were higher for the nonfixation group when compared to the fixation group.

Conclusions

This is the first known series examining surgical outcomes of osteochondral fractures of the patella following patellar dislocations in the adolescent population. While patients without fixation were less symptomatic in this series, this may be attributable to more severe injuries in patients undergoing fracture fixation.

Level of evidence

Retrospective case series, Level IV.     

分体式髌骨爪与髌骨环固定治疗髌骨骨折的疗效比较

对27例髌骨骨折采用髌骨爪内固定治疗,对24例髌骨骨折采用髌骨环内固定治疗,所有患者骨折均获愈合.髌骨爪治疗组综合优良率95.05%,髌骨环组综合优良率83.73%.髌骨爪相比较髌骨环治疗髌骨骨骨折,操作简单,固定牢靠,适合各种髌骨骨折.     

Proximal patellar tendinosis and abnormalities of patellar tracking

Objective. To assess whether an association exists between patellar tendinosis and abnormal patellar tracking. Design and patients. The MRI examinations of 630 patients (i.e. 860 knees) referred with anterior knee pain over a 4-year period were assessed in retrospect for the presence of patellar tendinosis and abnormal patellar tracking. The images of the patients with patellar tendinosis were reviewed and the location within the patellar tendon was recorded. Results. There were 44 knees with proximal patellar tendinosis. Twenty-four of these were considered to have normal patellar tracking and 20 to have abnormal patellar tracking. In the group of 816 knees without proximal patellar tendinosis, 581 were considered to have normal patellar tracking and 235 knees to have abnormal patellar tracking. When the two groups were compared there was a statistically significant difference in the ratio of patients with and without abnormal tracking. Conclusion. In patients referred with anterior knee pain or suspected abnormal patellar tracking there is a significant association between proximal patellar tendinosis and abnormal patellar tracking. Received: 3 June 1998 Revision requested: 4 August 1998; 16 November 1998 Revision received: 9 November 1998; 18 January 1999 Accepted: 29 January 1999     

Anatomical study of the inferior patellar pole and patellar tendon

In this study, detailed investigations into the shape of the inferior patellar pole, the site of the patellar tendon attachment, and the length and course of the patellar tendon were performed with the aim of examining the anatomical factors involved in the developmental mechanism of patellar tendinitis. The investigation examined 100 legs from 50 cadavers. The inferior patellar pole was classified into three types: pointed, intermediate, and blunt. The attachment of the patellar tendon to the inferior patellar pole was classified into two types: an anterior and a posterior. The length of the patellar tendon was measured from the tibial tuberosity to the inferior patellar pole. The pointed type was seen in 57% of legs, the intermediate type in 21%, and the blunt type in 22%. Twenty‐one legs were the pointed type, as well as the anterior type. The patellar tendon was significantly shorter with the posterior type than with the anterior type. The blunt type also had a significantly shorter patellar tendon than the pointed type. In legs that were both the pointed type and the anterior type, the inferior patellar pole and the proximal posterior surface of the patellar tendon impinged during knee flexion due to the posterior tilt of the patella, suggesting the possibility that this may induce damage. With the posterior type and blunt type, on the other hand, the possibility of strong tensile stress on the tendon fibers of the posterior facet of the inferior patellar pole was suggested.     

Arthroscopic patellar reinsertion of the MPFL in acute patellar dislocations

Purpose  

The objective of this study was to evaluate the mid-term results of a new technique for the arthroscopic repair of MPFL after an acute patellar dislocation (APD).     

镍钛形状记忆合金聚髌器治疗髌骨骨折42例

 目的观察镍钛形状记忆合金聚髌器这一新型髌骨骨折内固定方法的疗效.方法选取我院1995年～2002年就诊的髌骨骨折患者42例,均符合手术适应证,采用镍钛形状记忆合金聚髌器治疗.结果经术后随访,优良率达97.6%,骨折愈合率达100%,随诊未发现聚髌器断爪、松动、戳破皮肤、骨折移位、骨不连及关节面阶梯等现象.结论该方法固定可靠,使用安全,疗效确切,符合髌骨骨折内固定的生物力学要求,改善了髌骨骨折内固定技术.     

镍钛记忆合金聚髌器治疗髌骨粉碎性骨折87例

报告镍钛记忆合金聚髌器治疗髌骨粉碎性骨折的方法和疗效.髌骨粉碎性骨折先行可吸收髌骨缝线环扎初步固定恢复髌骨软骨面平整,再采用镍钛记忆合金聚髌器环抱坚强固定.     

Bracing for patellar instability

Knee pain secondary to problems with patellar tracking is common. The initial treatment for these problems is conservative. Patellar orthotics have been used extensively to treat a variety of extensor mechanism problems. Millions of health care dollars are spent annually on the use of these braces. There are many different patellar orthotics on the market today. The use and design of most of these devices are unclear and often lack a solid biomechanical foundation. The practical mechanical function of these braces is to reduce the lateral displacement of abnormal patellofemoral tracking. Orthotics that are designed and tested using practical biomechanical principles for applying a medially directed force to the patella seem to have a role in treating patients with knee pain secondary to patellar malalignment and instability. Well-defined and controlled clinical studies of the use of patellar braces are lacking.