髌骨骨折后大髌骨现象形成及预防

目的：观察12例髌骨骨折后髌骨增大患临床表现，探讨大髌骨现象形成原因和预防。方法：观察1992～2001年问，12例骨折后髌骨增大患的骨折固定方式、临床表现和双侧X线片对比情况。结果：骨折后形成大髌骨，原固定方法分别为石膏、钢丝或丝线环扎、张力带或改良张力带固定等。患有膝关节酸痛、股四头肌乏力和伸膝困难等症状。体检和x线发现患侧髌骨较健侧增大，部分X线片显示有髌股关节退变。结论：大髌骨无特异性症状。根据体检和X线片发现患侧髌骨较健侧增大即可诊断大髌骨。不能很好掌握传统固定方式，或传统固定方式本身具有缺陷是产生大髌骨的主要原因。提高手术技巧，选择镍钛聚髌器等适当固定方式可预防大髌骨。

Cause and Prevention of Bigger Patella after Fracture

Objective:To observe clinical situation of 12 patients who have bigger patelae after fracture and to explore cause and prevention of big patella.Methods:From 1992 to 2001,21 patients with bigger patellas were reviewed.Fixation methods,symptoms,physical examination and bilateral X-rays of knee joints were investigated.Results:The primary fixation devices of fracture patellas were plaster cast,circumferential wire loop fixation,tension band fixation,or modified tension band fixation.The symptoms of bigger ptella included soreness of the knee,weakneess of quadriceps femoris,extension difficulty of knee joint,et al.Physical examination and X-rays show a bigger patella than the uninjured side.Degeneration signs of patella-femur joint were observed on some X-ray films.Conclusion:No characteristic symptom of bigger patellas.Dignosis can be achieved mainly according to physical examination and X-rays.Unproperly mastering conventional fixation methods and defects of conventional fixation methods are the prominent causes of bigger patellas.It is important to improve operation technique and to choose proper fixation methods such as nickel titanium patella concentrator(NT-PC)to prevent big patella.