聚酯编织线结合带锁扣线缆治疗严重髌骨粉碎性骨折

背景：以往采用张力带钢丝或钢丝环扎、镍钛聚髌器结合可吸收线、双环10号丝线环扎并分体式髌骨爪及记忆合金聚髌器治疗髌骨粉碎骨折时，难以达到髌骨骨折的坚强固定。 目的：探讨聚酯编织线缝扎结合带锁扣线缆环扎治疗严重髌骨粉碎性骨折的临床效果。 方法：回顾性分析2007年1月至2012年10月采用聚酯编织线缝扎结合带锁扣线缆环扎治疗的57例髌骨粉碎性骨折患者临床资料。根据AO分型，B3型9例，C2型22例，C3型26例。手术中确定髌骨满意复位后，先用粗聚酯编织线间断缝合两侧股四头肌扩张部，间断缝合骨膜及髌前组织，应用带锁扣线缆环扎固定，视骨折块稳定情况，用粗聚酯编织线在髌前组织行＂8＂字张力带固定。术后根据Bostman髌骨骨折临床评估标准评估疗效。 结果与结论：46例获得4-18个月随访，骨折愈合时间3-5个月；伤口均Ⅰ期愈合，无感染发生，骨折全部愈合，无钛缆松脱和皮肤刺激等并发症。按Bostman髌骨骨折疗效评分标准，优33例，良10例，可3例，优良率为93.5%。表明聚酯编织线缝扎结合带锁扣线缆环扎治疗严重髌骨粉碎性骨折能使骨折块紧密接触，固定可靠，可行早期功能锻炼。

Polyester braided wire and belt lock cable are employed for treatment of serious comminuted patellar fractures

BACKGROUND： Serious patellar comminuted fractures can be treated by a number of methods such as cerclage with tension band steel wire or steel wire, or fixation with the nickel titanium patella concentrator and absorption lines, or cerclage with 10# double-loop wire plus fixation with split-type patella claws or with the memory alloy patella concentrator. But it is difficult to achieve strongly fixed effect on patella fractures by these methods.
OBJECTIVE： To investigate the clinical effects of suture with polyester braided wire and cerclage with belt lock cable on serious comminuted patellar fractures.
METHODS： A retrospective analysis was performed on the clinical data of 57 patients with serious comminuted patellar fractures who received suture with polyester braided wire and cerclage with belt lock cable from January 2007 to October 2012. According to AO classification of fractures, there were nine cases of type B3, 22 cases of type C2 and 26 cases of type C3. After satisfactory reduction of comminuted patellar fractures during the operation, firstly we sewed up both sides of the expansion region of quadriceps muscle and stitched on periosteum and prepatellar tissue with thick polyester braided wire followed by patellar cerclage with belt lock cable. According to the stability of fracture blocks, tension band fixation with polyester braided wire was partially added. After the operation, the clinical effects were assessed based on the Bostman score system.
RESULTS AND CONCLUSION： Totally 46 out of 57 cases were followed up with an average of 8 months （4-18 months）. All patients obtained bone union within 3-5 months. Wounds healed in the first stage without any infections, and fractures in all patients healed without complications such as implant loosening and skin irritation. According to the Bostman score system, 33 cases were scored excellent, 10 good and three fair. The excellent and good rate was 93.5%. It suggests that treatment of serious patellar comminuted fracture by the combination of polyester braided wire and belt lock cable leads to closely contact fracture sites and reliably fix bone fragments. It can facilitate early postoperative range of motion exercises.