三种不同内固定植入物治疗髌骨粉碎性骨折的效果比较

背景:髌骨粉碎性骨折的手术治疗应尽量保留骨质及精确的复位内固定,充分恢复髌骨的功能,目前髌骨粉碎性骨折尚无统一的治疗标准,仍是临床上的难点. 目的:比较AO改良张力带、钛缆环扎及镍钛聚髌器固定法治疗髌骨粉碎性骨折的效果.设计:前瞻性对比观察.对象:选择2004-11/2006-11解放军第二军医大学长征医院骨科收治的60例单纯单侧闭合性髌骨粉碎性骨折患者,男32例,女28例,年龄28～59岁.纳入标准:明确诊断为单纯单侧闭合性髌骨粉碎性骨折,受伤时间< 7 d.患者均对手术项目知情同意.方法:根据患者意愿选择手术方式,将患者分为AO改良张力带固定组(n =22)、钛缆组(n =21)、聚髌器组(n=17).AO改良张力带组中12例行AO改良张力带单纯内固定,10例行AO改良张力带内固定取出术;钛缆组均行钛缆环扎术;聚髌器组中10例行聚髌器单纯内固定术,7例行内固定取出术. 主要观察指标:①观察术后有无宿主及材料反应,比较术中出血量、住院医疗费用以及工作日损耗.②比较术后3个月患膝主动活动范围及术后6个月术后功能恢复情况及疗效.结果:纳入患者60例均进入结果分析.①所有病例均未发生宿主或材料反应,聚髌器组患者术中出血量明显多于AO改良张力带单纯内固定组和钛缆组,工作日损耗少于AO改良张力带单纯内固定组,差异均有统计学意义(P < 0.05);钛缆组住院医疗费用明显多于聚髌器及AO改良张力带单纯内固定组,差异有统计学意义(P < 0.05).②钛缆组患者患膝活动度最大,平均108°左右,远期患膝功能评分最高,平均21.3分,优良率达95.2%,且没有明显严重并发症,均明显优于其它组别,差异有统计学意义(P < 0.05).结论:AO改良张力带固定与聚髌器固定治疗某些髌骨粉碎性骨折能达到优良效果.钛缆环扎法适合髌骨粉碎性骨折的治疗并可取得更好的膝关节功能恢复.

Comparison of curative effects among three internal fixation implants for comminuted patellar fracture

BACKGROUND: Bone and exact reduction and internal fixation should be kept to fully repair the function of patella in comminuted patellar fracture operation. Currently, comminuted patellar fracture without a unified therapeutic standard has been a difficulty in clinic.OBJECTIVE: To compare the effects of modified AO tension band, titanium cable cerclage and nickel-titanium (Ni-Ti) patellar concentrator fixation in the treatment of comminuted patellar fracture.DESIGN: Prospective comparative observation.PARTICIPANTS: Totally 60 patients with simple unilateral closed comminuted patellar fracture were enrolled at Department of Orthopaedics of Changzheng Hospital from November 2004 to November 2006, including 32 males and 28 females aged 28-59 years. Inclusive criteria contained diagnosis of having simple unilateral closed comminuted patellar fracture and injury timing of less than 7 days. The patients all signed the informed consent.METHODS: The patients were assigned into modified AO tension band group (n =22), titanium cable cerclage group (n = 21) and Ni-Ti patellar concentrator group (n =17) according to their will. Twelve patients in the modified AO tension band group received simple modified AO tension band internal fixation, and ten received modified AO tension band internal fixation and extraction. Patients in the titanium cable cerclage group received titanium cable cerclage. Ten patients in the Ni-Ti patellar concentrator group received simple Ni-Ti patellar concentrator internal fixation, and seven received internal fixation and extraction.MAIN OUTCOME MEASURES: ①Postoperative host and material reaction, intraoperative blood loss, medical cost and workday loss, and ②active range of knee motion at month 3 after operation and functional recovery and curative effect at month 6 after operation.RESULTS: Totally 60 patients were involved in the result analysis. ①Host and material reaction was not found in all patients. Blood loss was significantly more in the patients of simple Ni-Ti patellar concentrator internal fixation group than patients of simple modified AO tension band internal fixation group and titanium cable cerclage group, whereas workday loss was less than that of the simple modified AO tension band internal fixation group (P < 0.05). Medical cost was obviously more in the titanium cable cerclage group than the simple Ni-Ti patellar concentrator internal fixation group and the simple modified AO tension band internal fixation group (P < 0.05). ②Active range of knee motion was the largest, about mean 108°, and long-term functional score of injured knee was the highest, about mean 21.3 points, with the excellent and good rate of 95.2%, and no sever complication appeared in the titanium cable cerclage group. These were much better than those of the other groups (P < 0.05).CONCLUSION: Modified AO tension band fixation and patellar concentrator fixation in the treatment of comminuted patellar fracture have excellent effects in some patients. Titanium cable cerclage fits for the treatment of comminuted patellar fracture and has better recovery of knee joint function.