空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效分析

目的　探讨空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效。 方法　2005 年 6 月－ 2010 年 9 月采用空心拉力螺钉联合钢丝张力带治疗髌骨骨折患者 38 例，男 29 例，女 9 例；年龄 32 ～ 69 岁，平均 42.2 岁。 其中髌骨中份横行骨折 18 例，斜行骨折 15 例，髌骨纵行骨折 3 例，髌骨下极骨折 2 例。骨折块移位 0.6 ～ 3.2 cm， 平均 1.7 cm。受伤至手术时间 1 ～ 7 d，平均 2.1 d。末次随访时评估双侧膝关节主观感受、视觉模拟评分（VAS）、患 侧膝关节活动度（ROM）、Lysholm 评分及影像学变化。 结果　患者随访 13 ～ 54 个月，平均 19.5 个月。康复期内 未出现皮肤刺痛、滑囊炎、切口延期愈合或不愈合等临床并发症。末次随访时疼痛 VAS 评分（1.5 ± 0.9）分，患侧膝 ROM 为健侧的 85.2%。术后 2.1 ～ 3.2 个月，平均 2.8 个月达到临床骨性愈合标准。 患侧 Lysholm 评分优 27 例、良 8 例、可 1 例、差 2 例，优良率 92.1%；健侧膝关节 Lysholm 评分优 35 例、良 1 例、可 0 例、差 2 例，两侧比较差异 无统计学意义（P ＞ 0.05）。 结论　空心拉力螺钉联合钢丝张力带治疗髌骨骨折可获得较好临床疗效，且术后循序 渐进的康复锻炼是膝关节功能得到最大恢复的关键。

The Therapeutic Effect of Hollow Lag Screw Combined with Tension Band for Patellar Fracture

Objective To investigate the therapeutic effect of hollow lag screw combined with tension band for patellar fracture. Methods From June 2005 to September 2010, 38 patients with patellar fracture including 29 males and 9 females were treated with hollow lag screw plus tension band. The average age of these patients was 42.2 years old, ranging from 32 to 69. Among them, 18 had longitudinal fractures, 15 had transverse fractures, 3 had oblique fractures and 2 had fractures of inferior polar of the patella. The average displacement of fracture was 1.7 cm, ranging from 0.6 to 3.2. The time from the occurrence of fracture to operation was ranged from 1 to 7 days, averaging at 2.1 days. Subjective feeling, visual analogue scale, Lysholm knee score and radiographic imaging of knee joint were used to evaluate the efficacy during the last follow-up. Results　The patients were followed up for 13 to 54 months with an average period of 19.5 months. No patients had such complications as skin stabbing pain, bursitis, delayed healing of wound and fixation failure during rehabilitation period. At the final follow-up, mean score of VAS was (1.5 ± 0.9), and the motion range of affected knees was 85.2% of that of healthy knees. The bone healing time was 2.1 to 3.2 months after surgery with an average period of 2.8 months. According to Lysholm knee score, 27 of affected knees were in excellent condition, 8 were good, 1 was fair and 2 were poor, with an excellent and good rate of 92.1%; 35 of healthy knees were excellent, 1 was good and 2 were poor, without significant difference from the affected knees. Conclusion　Hollow lag screw plus tension band to treat patellar fracture can obtain excellent clinical efficacy and step-by-step rehabilitation process is the key to the maximal function recovery of the knee.