三种不同内固定方法治疗髌骨骨折的疗效比较及对膝关节功能的影响

目的探讨应用粗丝线或可吸收粗线环形缝合固定法、改良张力带钢丝内固定术、镍钛记忆合金聚髌器三种不同方法治疗髌骨骨折的手术效果以及其对膝关节功能的影响。方法 90例髌骨骨折患者根据手术固定方法不同随机分为A、B、C三组各30例,A组:应用粗丝线或可吸收粗线环形缝合固定法治疗,B组:采用改良张力带钢丝内固定术,C组采用镍钛记忆合金聚髌器,分析比较三种不同内固定方法术后3个月、6个月的治疗效果以及对膝关节功能的影响。结果三组手术方法的平均术中及术后出血量、手术时间及住院时间比较,差异并无显著性。但术后3个月A组、B组膝关节活动度(ROM)的有效率明显低于C组,经χ2检验显示,差异有显著性(χ2=6.412,P0.05)。术后6个月三组临床疗效比较:A组、B组的总有效率明显低于C组,差异有显著性(χ2=7.523,P0.05)。结论改良张力带固定法、镍钛聚髌器固定法的手术治疗方法在解剖复位,坚强的内固定加早期的关节持续被动运动方面优于粗丝线或可吸收粗线环形缝合固定法。同时借助CPM机被动加主动训练,增强伤肢的静脉回流,减轻疼痛和肿胀,能有效避免创伤性骨关节炎,利于软骨营养,明显加速关节功能恢复。

Three Different Fixation Methods for Treatment of Patellar Practures and the Impact on Knee Function

Objective To study the thick rough silk or absorbable suture ring, modified tension band wire fixation, nickel titanium memory alloy patellar three different methods of surgical treatment of patellar fracture effect, and the knee function impact. Methods 90 eases of patellar fracture fixation surgery in patients under different randomly divided into A, B, C three groups of 30 cases, A Group： Applied coarse silk or absorbable suture treatment of thick ring, B group： use of modified tension band wire fixation,C group were nickel-titanium memory alloy patella, analysis and comparison of three different methods of internal fixation after 3 months, 6 months of treatment, and the knee function. Results Of three surgical methods, the average intraoperative and postoperative blood loss, operating time and hospital stay, the difference was not statistically significant. But after 3 months A group, B group activity knee （ROM） was remarkably lower than the C group, by X2 test showed significant difference （ x2= 6.412,P〈0.05）. After 6 months of clinical effects of three groups： A group, B group was significantly lower than the total effective C group, the difference was significant （ X 2=7.523, P〈0.05）. Conclusion The modified tension band fixation, nickel titanium patellar fixation in surgical treatment of anatomical reduction, rigid internal fixation and early joint continuous passive motion is better than thick rough silk or absorbable suture fixation ring with CPM, while the passive plus active training, enhance the Limbs of the venous return, reduce pain and swelling, can effectively avoid the traumatic osteoarthritis,cartilage nutrition help significantly accelerate the restoration of joint function.