治疗髌骨下极骨折不同手术方式的对照研究*

目的对比分析3种不同内固定方式治疗髌骨下极骨折的临床疗效,探讨袢钢板结合髌骨爪治疗髌骨下极骨折的优缺点。方法回顾性分析本院自2011年7月至2018年1月收治的81例髌骨下极骨折的患者,将其分为A组(袢钢板结合髌骨爪固定30例)、B组(张力带固定26例)、C组(荷包缝合辅助外固定25例);统计3种手术的操作时间、术中出血量、骨折愈合时间及术后1年膝关节屈膝角度,对比分析3组的膝关节功能及临床疗效。结果膝关节Bostman功能评分:A组为100%,B组为80.77%,C组为72%,A组膝关节功能评分明显优于B组和C组(P0.05)。术后1年关节屈膝角度A组优于B组和C组(P0.05)。在手术操作时间上,A组高于B组和C组(P0.05)。术中出血量A组高于B组和C组,但与B组比较差异无统计学意义(P0.05),与C组比较差异有统计学意义(P0.05),三组骨折愈合时间比较差异无统计学意义(P0.05)。A组未见明显并发症;B组有4例出现克氏针退针,2例因内固定失效致关节僵硬;C组患者有4例出现股四头肌萎缩,7例关节僵硬。结论袢钢板结合髌骨爪治疗髌骨下极骨折虽然术中操作时间略长,但内固定坚强可靠,术后能早期行康复功能锻炼,关节功能及活动度恢复好,并发症少。

A comparative study of different surgical methods for the treatment of patellar inferior pole fracture

Objective To compare and analyze the clinical effects of three different internal fixation methods for the treatment of patellar inferior pole fracture, and to explore the advantages and disadvantages of loop plate combined with patellar claw in the treatment of patellar inferior pole fracture. Methods A retrospective analysis was made on 81 cases of patellar inferior pole fracture treated in our department from July 2011 to January 2018. They were divided into group A (30 cases of patellar claw fixation with loop plate), group B (26 cases of tension band fixation) and group C (25 cases of purse suture assisted external fixation). The operation time, intraoperative bleeding volume, fracture healing time and knee flexion angle 1 year after operation were counted and compared. The knee function and clinical efficacy of the three groups were analyzed. Results The Bostman function score of knee joint was 100% in group A, 80.77% in group B and 72% in group C. The knee function score of group A was significantly better than that of group B and C (P<0.05). The knee flexion angle of group A was better than that of group B and C one year after operation (P<0.05). The operation time of group A was longer than that of group B and group C (P<0.05). The intraoperative bleeding volume in group A was higher than that in group B and C, but there was no significant difference in statistics between group B and C (P>0.05), and there was significant difference in statistics between group A and group C (P<0.05), and there was no significant difference in fracture healing time among the three groups (P>0.05). There were no obvious complications in group A, 4 cases in group B and 2 cases of stiffness due to failure of internal fixation. There were 4 cases of quadriceps femoris atrophy and 7 cases of stiffness in group C. Conclusion Although the operation time of loop plate combined with patellar claw in the treatment of patellar inferior pole fracture is slightly longer, the internal fixation is firm and reliable. Early rehabilitation exercises can be performed after operation. The joint function and range of motion recover well with fewer complications.