髌骨粉碎性骨折3种固定方式比较分析

目的：通过对比髌骨粉碎性骨折不同固定方法的临床疗效,为髌骨粉碎性骨折的治疗提供选择依据。方法：2003年2月至2009年6月采用3种固定方式治疗56例髌骨粉碎性骨折,其中采用克氏针钢丝固定（A组）18例,男9例,女9例;年龄32～52岁,平均（47.62±4.82）岁;丝线环扎配合石膏固定（B组）13例,男3例,女10例;年龄38～65岁,平均（48.58±8.28）岁;记忆合金聚髌器固定（C组）25例,男9例,女16例;年龄32～68岁,平均（48.36±9.59）岁。按改良B觟stman评估标准,对3组的膝关节活动度、疼痛、行走、上楼梯等8个方面进行评分比较。结果：所有病例获随访,时间8～26个月,平均15.6个月,骨折全部愈合。A、B、C组B觟stman评分的总平均分分别为（26.00±4.16）、（22.08±5.31）、（26.44±3.77）分,A、C组评分优于B组。结论：克氏针钢丝或聚髌器固定治疗髌骨粉碎性骨折,固定牢靠,功能恢复佳,疗效满意。

Comparison of clinical effects for three methods in treating comminuted patellar fractures

Objective: To compare clinical effects of different fixations in order to provide the best therapeutic choice for comminuted patellar fractures. Methods: From February 2003 to June 2009, 56 patients with comminuted patellar fractures were treated with three methods of fixation. Of them, 18 patients(group A) were treated with Kirschner-wire with steel wire fixation, there were 9 males and 9 females, ranging in age from 32 to 52 years with an average of (47.62±4.82) years;13 patients (group B) with circular silk thread fixation and plaster immobilization, there were 3 males and 10 females, ranging in age from 38 to 65 years with an average of(48.58±8.28) years;25 patients (group C) with memory alloy patella holder fixation, there were 9 males and 16 females, ranging in age from 32 to 68 years with an average of (48.36±9.59) years. According to criteria of Böstman, eight indexes were compared, including the range of motion of the knee, pain, walking and so on. Results: All patients were followed up from 8 to 26 months with an average of 15.6 months. All the fractures healed. The Böstman scoring of group A, B, C were respectively 26.00±4.16, 22.08±5.31, 26.44±3.77. The clinical effects of group A and C were better than that of group B(P<0.05). Conclusion: The method of Kirschner-wire with steel wire fixation or memory alloy patella holder fixation can obtain satisfactory effects in treating comminuted patellar fractures because of steady fixation and early function recovery.