关节镜下经皮改良张力带固定治疗髌骨骨折临床研究

目的　研究探讨髌骨骨折在关节镜下复位 ,经皮改良张力带固定的临床应用。方法　 33例新鲜髌骨骨折 ,其中横行骨折 9例 ,纵行骨折 3例 ,下极骨折 6例 ,粉碎性骨折 15例。成功 2 7例 ,失败 6例。手术通过关节镜清理关节腔内血凝块、碎骨块和骨折块之间嵌顿的软组织 ,关节镜直视下观察骨折情况以指导骨折复位固定。在C臂X线透视下帮助骨折复位 ,关节镜观察关节面复位平整后 ,经皮平行打入两枚克氏针固定骨折块 ,皮下导入钢丝行改良张力带固定。结果　平均随访 16 .4个月 ,骨折愈合时间最短 6周 ,最长 10周 ,平均 7.3周。根据胥少汀综合评分法 ,优 2 4例 ,良 3例 ,中、差均无。结论　关节镜下经皮改良张力带固定治疗髌骨骨折为治疗新鲜髌骨骨折提供了一种新的治疗方法。具有手术创伤小 ,生理干扰小 ,可清除关节腔内血凝块、碎骨块 ,手术感染机会小 ,关节面复位好 ,固定坚强 ,早期功能锻练 ,术后功能恢复好等优点

Clinical study on the treatment of fractures of the patella by arthroscopy and percutaneous modified tension band

Objectives To investigate the clinical application of treatment of fractures of the patella by arthroscopy and percutaneous modified tension band.Methods Thirty-three patients who suffered from fresh fractures of the patella were treated under arthroscopy,there were transverse fractures in 9 cases,longitudinal fractures in 3 cases,fractures of the lower pole of the patella in 6 cases,comminuted fractures in 15 cases.Arthroscopic,management failed in 6 cases,this is all severe comminuted fractures.Twenty-seven fractures of patella were successfully treated with arthroscopy.The hemarthrosis,blood clot,soft tissue of insertion and fragments were irrigated with arthroscopy.The fractures were closed by manipulation and percutaneously applied towel clips,while assessing the conditions of the fracture with arthroscope,and confirming it with C-arm X-ray.When the reduction had been achieved,two kirschner's needles were inserted parallel to fracture fragments with the C-arm X-ray.Once these had been accurately placed,the percutaneous tension band wires were made with small incisions.Results Twenty-seven cases were followed-up for 9-39 months,average of 16.4 months.According to Xu Shao Ting's criterion,24 cases had excellent results,3 cases had good results.Conclusions Arthroscopic management of fractures of the patella have the advantages of accurate reduction and fixation,lavaging and removal of blood clot,soft tissue of insertion and fragments.In addition there is less surgical exposure and infection opportunities and complications.This has led to far less disability and discomfort,substantially shorter hospitalization and accelerated recovery.So arthroscopic management of fractures of the patella offers a new method for treatment of fractures of the patella.