髌骨骨折三种内固定方法的疗效比较
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[摘要] 目的：探讨3种内固定方法在髌骨骨折治疗中的疗效。方法：选择176例髌骨骨折患者，随机分为3组，形态记忆双向张力钩固定术63例为A组，钢丝粗线环扎术58例为B组，镍钛聚髌器内固定术55例为C组。结果：所有患者均获得随访3～24个月， A、B、C三组的骨折愈合率分别为：95.24%、75.86%、85.45%。结论：形态记忆双向张力钩固定术治疗髌骨骨折具有可靠的生物力学固定效果，疗效满意，值得临床大力推广应用。
[关键词] 髌骨骨折；形态记忆双向张力钩固定术；钢丝粗线环扎术；镍钛聚髌器内固定术
[中图分类号] R683.4 [文献标识码]A[文章编号]1674-4721(2011)07(c)-047-02
The comparative of effects on three internal fixation methods in treating patellar fractures
ZHAO Jinping1, LI Huijiong1, CHEN Jingchao2, LUO Xiaowei1, LI Qifu1, HUANG Huanxiao1, MO Wenhui1
1.Gaobu Hospital of Dongguan City, Guangdong Province, Dongguang 523270, China; 2.Shijie Hospital of Dongguan City, Guangdong Province, Dongguan 523290, China
[Abstract] Objective: To discuss the effects of three internal fixation methods in treating patellar fractures. Methods: Chose 176 patients with patellar fracture, and randomly divided into three groups, the two-way shape memory tension hook was group A, there were 63 cases in it. The sreel wire prick were group B, there were 58 cases in it. The poly-patella utensil internal fixation was group C, there was 55 cases in it. Results: All patient had got the follow-up visit for three to twenty for months, fracture scar over rate of A、B、C groups were 95.24 percent, 75.86 percent, 85.45 percent. Conclusion: The patellar fractures is treated by the two-way shape memory tension hook, has credible animal mechanics fastness effect, satisfying curative effect, it′s good for spread and exploitation in clinical.
[Key words] Patella fracture; Two-way shape memory tension hook fixation; Thick cerclage wire; Nickel-titanium fixation of patellar
髌骨骨折是一种常见的关节内骨折，发生率约占全身各部位骨折的1%[1]，其复位固定要求较高，髌骨骨折治疗稍有不当就会引起创伤性关节炎、关节僵硬等并发症[2]。近年来对于髌骨骨折的手术治疗方法文献报道种类繁多[3]，无论选择哪一种手术方式，其治疗的目的都是修复伸膝装置，尽可能解剖复位骨折，缩短骨折临床愈合时间，保证膝关节早期有效康复锻炼[4]。2008年1月～2011年1月，本科手术治疗髌骨骨折分别选用形态记忆双向张力钩固定术、钢丝粗线环扎术和镍钛聚髌器内固定术，取得了满意的疗效，现总结分析报道如下：
1 资料与方法
1.1 一般资料
本组176例，男129例，女47例，年龄18～66岁，平均(36.2±3.3)岁，致伤原因：摔伤85例，车祸伤62例，坠落伤29例；左侧127例，右侧49例；闭合性骨折138例，开放性骨折38例。骨折类型：单纯横形骨折87例，粉碎性骨折39例，纵性骨折34例，撕脱骨折16例。伤后3～12 d手术。随诊时间10～22个月，平均(11.8±2.5)个月。并随机分为内固定方式A组(形态记忆双向张力钩固定术)63例，B组(钢丝粗线环扎术)58例，C组(镍钛聚髌器内固定术)55例。
1.2 手术方法
1.2.1 形态记忆双向张力钩固定术术前选择适合的无菌张力钩，并放入0～5℃的无菌生理盐水中。在腰硬联合麻醉或局麻下，取仰卧位，在髌前正中直切口，骨折断端显露后，清除骨折端血凝块、关节内积血和关节内碎骨屑，并冲洗关节腔。对于粉碎性骨折可先临时复位固定。髌内、外侧支持带及髌前筋膜使用7号线修复，按照张力钩各爪的走向在股四头肌腱和髌前附着处作小切口 ......
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