空心拉力螺钉加镍钛聚髌器置入内固定重建骨折髌骨的生物力学条件

背景：目前临床治疗髌骨骨折的内固定方法众多，但各有优缺点。内固定方法的选择是否合适，将直接影响髌骨骨折愈合时间及膝关节功能恢复。目的：评估空心拉力螺钉加镍钛聚髌器置入内固定治疗髌骨骨折后的生物力学重建效果。方法：回顾性分析2011年1月至2012年1月复旦大学附属金山医院骨科收治的新鲜髌骨骨折患者27例，横形骨折13例，粉碎骨折11例，上或下极骨折3例。采用空心拉力螺钉加镍钛聚髌器置入内固定，不需石膏外固定，内固定后自第2天开始行股四头肌主动收缩训练，内固定后1周开始床上屈伸膝关节锻炼。采用BSstman髌骨骨折疗效评定标准进行膝关节功能评价。结果与结论：27例患者均获随访，随访时间4—14个月。切口均获I期愈合，无内固定断裂或脱落、切口感染、皮肤坏死等并发症。骨折平均愈合时间为8．5周，无延迟愈合发生。根据BOstman评分标准，平均分为27．9分，其中优22例（81％）、良4例（15％）、差1例（4％），优良率为96％。结果显示，在空心拉力螺钉的基础上辅以镍钛聚髌器固定兼具传统各种内固定方法之优点，同时避免了其不足之处。

Biomechanical requirement for the reconstruction of patellar fracture treated with cancellous bone screw and nickel-titanium-patellar concentrator internal fixation

BACKGROUND： There are various internal fixation methods for the clinical treatment of patellar fractures, but each method has advantages and disadvantages, respectively. The selection of proper internal fixation method will directly affect the healing time and recovery of knee joint function.OBJECTIVE： To investigate the biomechanical reconstruction effect on pateliar fracture treated with cancellous bone screw and nickel-titanium-patellar concentrator internal fixation. METHODS： A retrospective analysis was performed on 27 cases of acute patellar fracture patients from January 2011 to January 2012 in the Department of Orthopedics, Jinshan Hospital, Fudan University, including 13 cases of transverse fracture, 11 cases of comminuted fracture and three cases of upper or lower pole fracture. All the 27 patients received cancellous bone screw and nickel-titanium-patellar concentrator internal fixation without plaster external fixation, and then the quadriceps active contraction training was performed from the 2nd day after internal fixation, and bed knee flexion and extension exercises were performed at 1 week after internal fixation. The knee joint function was evaluated with BSstman score system. RESULTS AND CONCLUSION： All the 27 patients were followed-up for 4-14 months. Incisions obtained stage I healing, and there was no fracture fixation or shedding, wound infection, skin necrosis or other complications. The average healing time was 8.5 weeks without delayed healing. According to clinical grading scale of B5stman score system, the mean score was 27.9, included 27 cases of excellent （81%）, four cases of good （15%）, one case of poor （4%）, and the excellent and good rate was 96%. The results suggest that cancellous bone screw combined with nickel-titanium-patellar concentrator internal fixation can maintain the advantages of traditional internal fixation method, and can avoid the disadvantages of the traditional internal fixation method.