关节镜下微创克氏针张力带内固定治疗横形髌骨骨折的临床分析

目的探讨关节镜下微创克氏针张力带内固定治疗横形髌骨骨折的临床效果。方法选取2016年3月至2018年3月河北省开滦总医院林西医院骨科收治的108例横形髌骨骨折患者进行回顾性分析,按照手术方式不同,分为关节镜组68例,对照组40例。关节镜组患者采用关节镜下微创克氏针张力带内固定术,对照组采用切开复位克氏针张力带内固定术。比较两组患者手术情况、临床疗效、随访Lysholm评分、视觉模拟评分(visual analogue scale,VAS)。结果关节镜组的切口长度(3.5±0.8)cm]短于对照组(13.7±2.2)cm],术中出血量(47.4±12.5)ml]明显少于对照组(86.9±14.7)ml],住院时间(11.8±2.6)d]和骨折愈合时间(11.5±2.4)周]明显少于对照组(15.8±3.0)d、(15.7±2.8)周],差异有统计学意义(t值分别为34.63、14.85、7.29、8.25,P均<0.05)。两组患者Lysholm评分随时间的推移显著升高(F组内=87.53,P<0.05)。关节镜组Lysholm评分升高幅度高于对照组(F交互=7.64,P<0.05)。关节镜组Lysholm评分整体水平高于对照组(F组间=11.42,P<0.05)。两组患者VAS评分随时间的推移显著下降(F组内=76.47,P<0.05)。关节镜组VAS评分下降幅度显著高于对照组(F交互=9.96,P<0.05)。关节镜组VAS评分整体水平显著低于对照组(F组间=10.38,P<0.05)。结论关节镜下微创克氏针张力带内固定治疗横形髌骨骨折具有较好的效果和安全性,损伤较小,术后疼痛轻。

Clinical analysis of arthroscopic minimally invasive Kirschner wire tension band internal fixation for transverse patellar fracture

Objective To investigate the clinical effect of arthroscopic minimally invasive Kirschner wire tension band internal fixation in the treatment of transverse patellar fracture.Methods From March 2016 to March 2018,108 patients with transverse patellar fracture admitted to the Department of orthopedics,Linxi hospital,Kailuan general hospital,Hebei Province were analyzed retrospectively.According to the different operation methods,the patients were divided into arthroscopic group(68 cases)and control group(40 cases).The patients in the arthroscopic group were treated with arthroscopic minimally invasive Kirschner wire tension band internal fixation,and the patients in control group were treated with open reduction and Kirschner wire tension band internal fixation.The operation condition,clinical efficacy,Lysholm score and visual analogue scale(VAS)score were compared between the two groups.Results The incision length((3.5±0.8)cm)of arthroscopic group was shorter than that of control group((13.7±2.2)cm),the amount of intraoperative bleeding((47.4±12.5)ml)was significantly less than that of control group((86.9±14.7)ml),and the length of hospitalization((11.8±2.6)d)and fracture healing time((11.5±2.4)weeks)were significantly less than those in control group((15.8±3.0)d,(15.7±2.8)weeks),the difference was statistically significant(t value were 34.63,14.85,7.29,8.25;all P<0.05).The Lysholm score of two groups increased significantly with time(Fintra-group=87.53,P<0.05).The increasing of Lysholm score in arthroscopic group was significantly higher than that in control group(Finteraction=7.64,P<0.05).The overall level of Lysholm in arthroscopic group was significantly higher than that of control group(Finter-group=11.42,P<0.05).The VAS score of two groups decreased significantly with time(Fintra-group=76.47,P<0.05).The decreased of VAS score in arthroscopic group was significantly higher than that in control group(Finteraction=9.96,P<0.05).The overall level of VASin arthroscopic group was significantly lower than that of control group(Finter-group=10.38,P<0.05).Conclusion Arthroscopic minimally invasive Kirschner wire tension band internal fixation for the treatment of transverse patellar fracture has better efficacy and safety,less injury,less pain after operation.