纵向钢丝捆绑结合克氏针张力带治疗髌骨下极粉碎骨折

目的：为达到稳定的骨折固定，牢固的骨性愈合，满足患者术后即刻开始功能康复的要求，使用纵向钢丝捆绑结合克氏针张力带的方法治疗未累及关节面的髌骨下极粉碎骨折，观察其并发症并评价疗效。方法： 回顾性研究了2013年1月至2015年1月使用纵向钢丝捆绑结合克氏针张力带治疗的15例髌骨下极粉碎骨折，其中男11例，女4例，平均年龄(54.5±6.9)岁，平均伤后(4.5±1.4) d行手术治疗。对患者的一般情况、受伤机制、局部软组织情况、骨折的类型等进行记录和分析，患者行术前CT检查以判断和测量下极骨折块的形态和大小，术后对患者进行连续随访，定期拍摄X线片，观察并记录骨折愈合情况及相关并发症并在最终随访时进行功能评分。结果： 随访时间为（13.1±2.1）个月，所有患者均恢复顺利，未出现感染、骨折不愈合、内固定物失效等并发症。患者膝关节平均活动范围为126.7°±6.9°，与对侧肢体相比，屈曲活动范围平均减少10.3°±8.8°。根据Bstman评分系统评判，优良率达100%，平均（28.9±1.1）分。结论： 对于未累及关节面的髌骨下极粉碎骨折，可首先通过纵向钢缆捆绑复位并且维持复位，同时结合克氏针张力带固定可提供非常可靠的骨性固定，操作简单、安全，能够满足术后即刻开始功能康复的要求，膝关节功能可得到很好的恢复，疗效满意。

Separate vertical wiring combined with tension band and Kirschner-wire plus cer-clage wire in the treatment of displaced inferior pole fractures of the patella

Objective：To investigate the clinical efficacy and outcomes of two separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire in the treatment of displaced inferior pole fractures of the patella. Methods: From January 2013 to January 2015, 15 consecutive patients (mean age 54.5 years) with inferior pole fractures of the patella were retrospectively included in this study. All the patients underwent open reduction and internal fixation by separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire through longitudinal incision, 4.5 d (range: 3.1-5.9 d) after initial injury. A safety check for early knee range of motion was performed before wound closure. The complications including infection, nonunion, loss of fixation and any wire breakage or irritation from implant were recorded. Anteroposterior and lateral views of the knee joint obtained during the follow up were used to assess bony union based on the time when the fracture line disappeared. At the time of the final outpatient follow up, functional evaluation of the knee joint was conducted by B-stman system. Results: The follow-up time was 13.1 months (range: 12-19 months) after surgery on average, immediate motion without immobilization in all the cases was allowed and there was no case of reduction loss of the fracture and wire breakage. There was no case of irritation from the implant. At the final follow-up, the average range of motion (ROM) arc was 126.7° (range: 115°-140°), the average ROM lag versus contralateral healthy leg was 10.3° (range: 0°-35°). The mean B-stman score at the last follow-up was 28.9 (range: 27-30), and graded excellent in most cases. Conclusion: Two separate vertical wiring is an easy and effective method to reduce the displaced inferior pole fracture of patella. Augmentation of separate vertical wiring with tension band and Kirschner-wire plus cerclage wire in these patients provides enough strength to protected the early exercise of the knee joint and uneventful healing. By this surgical treatment, excellent results in knee function can be expected for cases of displaced inferior pole fractures of the patella.