改良髌骨部分切除术生物力学实验与初步临床报道

作者通过５条下肢的体外力学测试，研究了髌骨部分切除、髌韧带重新附丽的部位对膝关节完全伸直时所需股四头肌力的影响，并测试了钢丝（直径０．４ｍｍ、双股）附丽髌韧带的最大固定力量。实验结果证明髌骨下１／４切除，髌韧带附丽贴近髌骨前面骨皮质对膝关节完全伸直时所需股四头肌力无显著影响（ｐ＞０．０５）髌骨下１／４切除、髌韧带附丽贴近关节软骨面将显著增大膝关节完全伸直时所需股四头肌力（ｐ＜０．００１）；钢丝附丽髌韧带的最大固定力量为６７．４ｋｇ（６０．９～７２．５ｋｇ）。我科自１９９２年１０月以来，采用髌骨部分切除、钢丝重新附丽髌韧带贴近髌骨前面骨皮质的改良方法治疗髌骨上、下极骨折１３例，按陆裕朴的评定标准，优良率达１００％。文中讨论了该术式的手术方法、手术时机、指征及术后处理。

Biomechanical Experiment and a Preliminary Report Following Modified Partial Patellectomy for Polar Fracture of the Patella

Orthopaedic Department,Research Institute of Surgery,Daping Hospital, Third Military College,Chongqing 630042. We studied the effect of partial patellectomy and reattachment of the patellar tendon on the extension force of quadrcepd to full extension against gravity by means of mechanical test of 5 lower limbs in vitro.We also assessed the fixation power of the wire reattachment patellar tendon.The results of this study are as follows.(1) The removal of the lower 1/4 fragment of the patella and anterior reattachment of the patellar tendon has no significant effect on the extension force of quadriceps to full extension against gravity(P>0.05);the posterior reattachment of the patellar tendon increases significantly the extension force of quadriceps to full extension against gravity(P<0.001).(2) The fixation power of the wire reattachment patellar tendon is 67.4kg(60.9 72.5kg).Since 1992 the authors adopted a modified partial patellectomy to treat 13 patients with polar fracture of the patella.All patients were satisfied with the results.In this paper,we also discussed the operation method,time indication and post operative treatment protocol.