髌鹰抓持器治疗尺骨鹰咀骨折

尺骨鹰咀骨折除小块撕脱外都涉及关节,对骨折复位要求高。我科应用自制的“髌鹰抓持器”于1987年7月～1995年4月治疗尺骨鹰咀骨折68例,取得了满意的疗效。报告如下。1 髌鹰抓持器的构造 髌鹰抓持器由固定爪、中心杆、钳型爪及弧型爪组成(附图)。弧型爪为治疗髌骨骨折用,钳型爪专为治疗尺骨鹰咀骨折而设计,具有一器两用的功能。固定爪通过螺母固定于中心杆一端,中心杆上设计有宽深2mm×2mm的滑槽与钳型爪套孔内锁销相嵌合,可避免钳型爪在固定骨折时发生旋转。钳型爪体部安装一带螺母的加压杆,以增加钳型爪的握持力。     

镍钛记忆合金抓髌器联合克氏针治疗髌骨粉碎性骨折

目的 探讨记忆合金抓髌骨器联合克氏针治疗髌骨粉碎骨折的临床疗效。方法 所有病人采用硬脊膜外阻滞麻醉，常规髌骨内侧弧形切口，清理关节内淤血后，10例仅行抓髌器固定，20例行复合式固定，术后3d屈伸活动膝关节，3周逐渐负重行走。结果 共治疗粉碎性骨折30例，除复合固定组1例因感染1周后取出内固定，其余病例骨折全部于手术后6～8周愈合，所有患者均术后随访，随访时间为8～74个月，优良率95％。结论 抓髌器联合克氏针治疗髌骨粉碎骨折克服了单纯应用抓髌器产生在骨折块间的剪切力作用，是治疗髌骨粉碎性骨折的首选方法。     

抓髌器与AO张力带治疗髌骨骨折疗效比较

目的：观察抓髌器治疗髌骨骨折疗效，探讨其适应症、治疗优点及发展方向。方法：一组病人用抓髌器治疗，一组病人行手术切开复位AO张力带钢丝内固定术。每组病人又分为术后1年，3年和5年进行随访。结果：抓髌器治疗髌骨骨折手术操作简单，对横断型髌骨骨折治疗效果佳；与同期AO张力带固定相比，横断型和粉碎型治疗效果无明显差异，而下极型以张力带固定治疗效果好。结论：横断型髌骨骨折是抓髌器治疗的适应症。     

聚髌器横向抓持固定有移位的髌骨纵形骨折

髌骨骨折采用相应固定器固定的目的是保持断端复位和对抗张应力〔1〕。 1993年 7月～ 2 0 0 0年 9月 ,笔者采用镍钛记忆合金聚髌器 (简称聚髌器 )横向抓持有移位或有移位倾向的髌骨纵形骨折 7例 ,效果满意。1　材料与方法1.1　病例资料　本组 7例 ,男 6例 ,女 1例 ,年龄 2 1～ 5 3岁。车祸伤 4例 ,跪跌伤 2例 ,直接击打伤 1例 ;闭合骨折 6例 ,开放骨折 1例 ;单纯髌骨骨折 5例 ,合并同侧股骨干、股骨下段骨折各 1例。伤后至手术时间 :最短3ｈ ,最长 8ｄ。1.2　固定方法　选连续硬膜外麻醉或全麻 ,大腿中上段扎气压止血带。作髌前横弧形切口常…     

抓髌器治疗髌骨骨折致髌骨不全愈合一例

抓髌器治疗髌骨骨折致髌骨不全愈合一例河北省大城县医院（３０２９００）肖崇峰宋××，女，５５岁。因搬物不慎摔伤左膝，Ｘ线片显示：左髌骨横断骨折，骨折块明显分离。来我院急诊在单侧腰麻下施行抓髌器外固定术，术后拍片骨折对位良好。６周后取下抓髌器，伤膝关节功...     

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。     

克氏针张力带法治疗髌尖撕脱骨折138例

髌尖撕脱骨折为髌骨骨折中较特殊类型的关节内骨折,自2000年10月至2005年6月,用克氏针张力带法临床治疗138例,通过内固定提高其稳定性和牢固性,有效地恢复髌骨外形,避免了髌骨的部分切除,不失为一种治疗髌尖骨折的安全有效方法。     

Cable Pin环扎固定与聚髌固定治疗老年髌骨粉碎骨折的比较

[目的]对比分析Cable Pin系统环扎固定与记忆合金聚髌器固定两种方法治疗老年髌骨粉碎骨折的技术及疗效。[方法]选取本科2010年8月~2014年4月收治的40例闭合性粉碎性髌骨骨折(Rockwood 5型)老年患者,随机分成环扎组和镍钛聚髌器组,每组20例,分别采用Cable Pin系统环扎固定与记忆合金聚髌器固定。观察并对比两组的治疗效果。[结果]40例患者,切口均甲级愈合,无感染发生,骨折全部愈合。除2例下肢静脉血栓外无其他并发症发生。以Bostman髌骨骨折疗效评分标准进行评分:总体优良率88%。手术时间环扎组长于聚髌器组,在关节屈曲角度、骨折愈合时间、Bostman髌骨骨折疗效评分方面环扎组优于聚髌器组,差异有统计学意义。[结论]Cable Pin系统环扎固定与记忆合金聚髌器固定两种手术方法,在出血量、术后并发症方面无明显差别,在手术时间方面记忆合金聚髌器固定优于Cable Pin系统环扎固定,而在膝关节屈曲角度、骨折愈合时间、Bostman髌骨骨折疗效评分方面环扎固定优于聚髌器固定。     

两种入路髓内钉固定治疗胫骨骨折的疗效比较

目的 比较髌下入路与半伸膝位外侧髌旁入路髓内钉固定治疗胫骨骨折的临床疗效。方法 将60例胫骨骨折患者根据手术入路方式的不同分为髌下入路组(30例,行髌下入路髓内钉固定)和髌旁入路组(30例,行半伸膝位外侧髌旁入路髓内钉固定)。记录两组手术情况,比较两组手术疗效。结果 患者均获得随访,时间14～20个月。手术时间、术中出血量髌旁入路组短(少)于髌下入路组,但差异均无统计学意义(P0. 05);术中透视次数、术中二次移位及术后膝前痛例数髌旁入路组明显少于髌下入路组,差异均有统计学意义(P 0. 05)。骨折愈合时间两组比较差异无统计学意义(P 0. 05)。末次随访时Lysholm膝关节评分髌旁入路组明显高于髌下入路组,差异有统计学意义(P 0. 05)。术后未发生切口深部感染、皮肤坏死、骨髓炎及内固定失效等严重并发症。髌下入路组1例发生切口浅表感染,经加强换药术后3周切口愈合。结论 髌下入路与半伸膝位外侧髌旁入路髓内钉固定治疗胫骨骨折均效果良好,但半伸膝位外侧髌旁入路可减少术中透视次数及二次移位发生,降低术后膝前痛发生率。     

改良张力带钢丝内固定治疗粉碎性髌骨骨折

髌骨骨折占全部骨骼损伤的1．65％，可由直接或间接外伤所致。髌骨骨折造成的直接影响是伸膝装置的连续性丧失及潜在的髌股关节失常。利用环扎髌骨及髌前张力带钢丝固定技术治疗粉碎性髌骨骨折仍存在切除髌骨的问题。2000年1月-2005年1月设计先用克氏针将骨折块复位固定，再用钢丝环扎髌骨及髌前“8”字张力带钢丝固定治疗粉碎性髌骨骨折，取得满意疗效。     

髌骨环治疗髌骨骨折

目的探讨髌骨环治疗髌骨骨折的疗效。方法对68例髌骨骨折患者应用髌骨环内固定。对骨折愈合情况、膝关节的疼痛及功能、影像学检查等进行评估分析。结果 62例获随访,6例失访,随访时间6~20个月。骨折平均愈合时间为3个月,无骨折再移位和内固定失效发生。根据B stman评分：优39例,良21例,差2例。术后膝关节的屈曲度为126.2°~134.6°（130.4°±2.1°）,患侧与健侧比较差异无统计学意义（P〉0.05）。结论应用髌骨环治疗髌骨骨折操作简单,固定灵活,复位满意;术后并发症少,有利于患膝早期功能锻炼,尤其适合髌骨粉碎性骨折。     

克氏针钢丝与髌骨针钛缆两种张力带固定治疗髌骨骨折

目的比较克氏针钢丝与髌骨针钛缆张力带固定治疗髌骨骨折的疗效。方法将128例髌骨骨折患者按固定方式分为A组(克氏针钢丝张力带固定,65例)和B组(髌骨针钛缆张力带固定,63例)。比较两组住院费用、住院天数、并发症发生率以及关节功能优良率。结果患者均获得随访,时间12~24个月。两组住院费用、住院天数、并发症发生率比较差异均有统计学意义(P<0.05)。两组关节功能优良率比较差异无统计学意义(P>0.05)。结论克氏针钢丝张力带固定术后并发症发生率较高,但关节功能优良率与髌骨针钛缆张力带固定比较无明显差异,且具有缩短住院时间、降低住院费用等优点。     

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。     

Biomechanical evaluation of various forms of fixation of transverse patellar fractures

A study was undertaken to evaluate the strength and ease of application of four different forms of patellar fracture fixation. Modified tension band, screw fixation, Lotke longitudinal anterior band (LAB), and Magnusson wiring were examined using a Materials Testing System. Using cadaver lower extremities, the tibia was mounted in a fixed base and the tibiofemoral joint was fixed at 36 degrees. Tension was applied to the patella through the quadriceps tendon and fracture displacement was measured with linear motion transducers. Based on the results, we recommend screw fixation for transverse patellar fractures in patients with adequate bone stock. In patients with patellar fractures with comminution and/or osteopenia, modified tension band fixation is recommended. Simple wiring techniques alone may not provide sufficient fixation to allow immediate range of motion.     

Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection

BACKGROUND: The ideal treatment for avulsion fractures of the inferior pole of the patella has not yet been identified. The options include (1) internal fixation of the pole fragment and (2) resection of the avulsed fragment and repair of the patellar ligament to the patella. We are not aware of any previous study in which the results of internal fixation have been compared with those of pole resection. The purpose of the present study was to compare the long-term results of internal fixation (with use of a basket plate) with those of pole resection. METHODS: We retrospectively studied two groups of patients who had had operative treatment of an avulsion fracture of the inferior patellar pole between 1990 and 1997. Fourteen patients had had internal fixation with a basket plate, and fourteen had had pole resection with patellar ligament repair. Eleven patients who had had internal fixation (Group A) and thirteen patients who had had pole resection (Group B) were followed for an average of 4.6 years. The final evaluation was based on the patellofemoral score, and the patellar height was measured radiographically. RESULTS: The average patellofemoral score (maximum, 100 points) was 94.1 points in Group A and 81.2 points in Group B. Significant differences between the groups were noted with regard to knee pain, level of activity, and range of motion. Normal patellar height was found in ten of eleven patients in Group A and in three of thirteen patients in Group B. Patella baja was significantly associated with a poor functional outcome. CONCLUSIONS: In patients who have sustained an avulsion fracture of the inferior patellar pole, the normal height of the patella can be maintained by preserving the patellar pole. In contrast with pole resection, which requires postoperative immobilization, internal fixation with a basket plate allows for immediate mobilization and early weight-bearing. The present study indicates that internal fixation with use of a basket plate can provide better clinical results.     

Quadriceps and patellar tendon ruptures

Ruptures of the quadriceps as well as the patellar tendon occur in low frequency, but cause major functional deficits of the leg. These injuries usually require operative treatment. Acute quadriceps tendon ruptures are treated by suture repair, using heavy sutures guided through bone tunnels in the patella. Chronic defects and neglected cases require a local tendon transfer, either by a quadriceps tendon turn-down or by a V-Y-plasty of the quadriceps tendon. Ruptures of the patellar tendon are treated by suture of the tendon stumps plus an reinforcement procedure protecting the tendon and avoiding secondary patella alta. Patello-tibial fixation may be achieved by a cerclage technique using wire or an autologous tendon strip, alternatively a patello-tibial external fixator can be applied. In chronic and neglected cases, patellar tendon reconstruction is performed with autologous tendon grafts or with soft tissue allografts. The graft must be protected by a patello-tibial fixation for the first weeks.     

The double contour sign of displaced vertical patellar fractures

Longitudinal patellar fractures occur rarely and are almost always treated non-operatively as they are usually undisplaced. We present two cases of displaced vertical patellar fracture in a 9-year-old girl and a 17-year-old-boy, both of whom required open reduction and internal fixation. We draw attention to a previously undescribed radiological double contour sign of the patella on the lateral view, which is pathognomonic of displacement in the anteroposterior plane. Its presence in vertical patellar fractures warrants open anatomical reduction and internal fixation to prevent late post-traumatic osteoarthrosis.     

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。     

镍钛聚髌器结合钢丝环扎固定治疗粉碎性髌骨骨折

目的：探讨镍钛聚髌器结合钢丝环扎固定治疗髌骨粉碎性骨折的临床疗效。方法：2004年3月至2007年6月,采用镍钛聚髌器结合钢丝环扎固定治疗38例髌骨粉碎性骨折,男25例,女13例;年龄21—64岁,平均42．5岁：均为粉碎有移位骨折,其中碎骨块3块16例、4块14例、5块及以上8例;合并其他部位骨折8例。随访期间评价患者膝关节功能及并发症情况。结果：经8-24个月（平均15个月）随访,骨折均骨性愈合。术后无内固定松动,发生膝关节创伤性滑膜炎2例。按Lysholm—Gillquist膝关节评价标准：优17例,良19例,可2例。结论：镍钛聚髌器结合钢丝环扎固定具有复位满意、固定可靠、患者可早期进行功能锻炼,是治疗髌骨粉碎性骨折的理想选择方式之一。     

Treatment of an intraoperative patellar fracture during revision total knee arthroplasty

An intraoperative vertical patellar fracture occurred through a central osteolytic defect during removal of a metal-backed patellar component. The fracture was treated successfully with cerclage wire fixation and implantation of a cemented patellar component.