带线锚钉结合Krackow-“8”字缝合法治疗髌骨下极骨折的疗效观察

目的 治疗髌骨下极骨折的传统方法主要有髌骨下极切除后缝合和保留髌骨下极的内固定技术,但都存在诸多不足,本研究探讨采用带线锚钉结合Krackow-“8”字缝合法治疗髌骨下极骨折,观察其临床疗效。 方法 使用带线锚钉治疗10例髌骨下极骨折患者,其中,男性5例,女性5例;年龄23~75岁,平均(46.00±19.48)岁;9例闭合骨折,1例开放性骨折(GustiloⅠ型)。在骨折近端拧入2枚锚钉,锚线分别行“8”字缝合和Krackow缝合。术后膝关节伸直位铰链支具保护,鼓励患者术后第3天开始,在铰链支具保护下屈曲膝关节功能锻炼,术后第2周在铰链支具的保护下开始部分负重,第6周开始去除铰链支具完全负重。术后定期返院复查,拍摄X线片评估锚钉位置和骨折愈合情况。 结果 所有患者均获得随访,随访时间为6~12个月,平均(7.90±2.28)个月。切口长度4~7 cm,平均(5.35±0.85) cm。术后3个月Bostman评分22~30分,平均(27.10±2.88)分,术后6个月Bostman评分23~30分,平均(28.30±2.21)分。术后6个月摄片提示髌骨骨折均骨性愈合。 结论 带线锚钉结合Krackow-“8”字缝合法治疗髌骨下极骨折早期疗效良好,具有创伤小、恢复快和无需二次取出的特点。 

Suture anchor and Krackow locking stitch for distal pole patellar fractures

Objective Suture after excision of inferior pole of the patella and internal fixation that reserved distal pole of the patella, the common routine therapy methods for distal pole patellar fractures, are both with some drawback. The aim of this paper is to explore the clinical efficacy of suture anchor and Krackow locking stitch in the treatment of distal pole patellar fractures. Methods The suture anchor and Krackow locking stitch were performed in 10 cases of distal pole patellar fractures, including 9 cases of closed fracture and 1 case of open fracture (Gustilo type Ⅰ), 5 male and 5 female patients, aged 23 to 75 (mean 46. 00 ±19. 48) years. Two suture anchors were twisted in the proximal section, and Krackow locking stitch was performed. Hinged knee brace was used to protect at knee extension. Knee flexion exercises protected by hinged knee brace were carried out in 3 days after the operation; Partial weight bearing exercise protected by hinged knee brace was performed at 2 weeks after the operation, and full weight-bearing ambulation without hinged knee brace protection was executed. The regularly reexamination after the operation was performed to check the position of anchors by X-ray and evaluate the healing of fractures. Results All patients were followed up, the average time was 6 to 12 months (mean7. 90 ±2. 28). The length of incision was 4 to 7 cm (mean 5. 35 ±0. 85) cm. Bostman patella fracture functional score was 22 to 30 points (mean 27. 10 ±2. 88) at 3 months after the operation and 23 to 30 points (mean 28. 30 ±2. 21) at 6 months after the operation. The bony union was showed by radiography 6 months after the operation in all fractures. Conclusion The suture anchor and Krackow locking stitch in the treatment of distal pole patellar fractures is with good early efficacy, less trauma and rapid postoperative recovery, avoiding the second operation.