可吸收螺钉加环扎治疗髌骨骨折的临床研究

目的探讨可吸收螺钉加环扎治疗髌骨骨折的临床疗效。方法 2009年6月至2012年6月采用可吸收材料治疗26例髌骨粉碎性骨折,男性15例,女性11例,年龄32～64岁,平均(43.0±4.1)岁；膝关节正中纵行切口,2枚4.0mm半螺纹可吸收钉于髌骨纵轴加压固定,1.5mm可吸收棒辅助固定；1号PDS II可吸收线环扎髌骨,并修复股四头肌腱扩张部；术后膝关节卡盘支具固定12周,随访终末行Bostman髌骨骨折评分,并测量膝关节活动度。结果26例患者术后随访平均(30.0±3.5)个月。骨折愈合时间平均为(10.50±1.30)周,无骨折延迟愈合及骨折不愈合,未出现螺钉断裂及切口感染等并发症。按Bostman评分评定疗效: 优22例,良4例,优良率100%。随访终末,膝关节平均活动度为3.3°±1.4°(伸),132.8°±4.1°(屈),与健侧相比差异无统计学意义(P>0.05)。结论可吸收螺钉加PDS可吸收线环扎治疗髌骨骨折临床疗效良好,无需行二次内固定取出手术。
Objective To evaluate the clinical efficacy of bioabsorbable screws and PDS strings in treatment of patellar fracture. Methods Twenty six patients with comminuted patellar fractures were treated by open reduction and fixation using PDLLA bioabsorbable screws and strings from June 2009 to June 2012. There were 15 men and 11 women with an average age of (43.0±4.1) years. The median approach was made to expose patellar fracture in front of knee. Two half-thread bioabsorbable screws(4.0mm diameter) were used to fix the patellar fractures. Meanwhile an absorbable rod(1.5mm diameter)was used to strengthen the fixation. The patellar was encircled and the injured expansion of four femoral head tendon was reconstructed by 1# PDSⅡabsorbable string. The affected limb was immobilized by the adjustable orthosis for 12 weeks after the operation. The average range of motion and the Bostman score were measured at the final follow-up. Results The average follow-up time was(30.0±3.5) months. The mean time of fracture union was(10.50±1.30) weeks. The complications such as delayed union, nonunion of fracture, screw broken and wound infection were not found. At the follow up, 22 cases were evaluated as excellent, 4 cases as good by Bostman score system with a rate of excellent and good of 100%. The average range of motion was 3.3°±1.4°(extension), 132.8°±4.1°(flexion) respectively. There were no significant differences contrasting to the contralateral limb in all cases(P>0.05). Conclusion The bioabsorbable screws and PDS string is the effective way to treat the patellar comminuted fractures without second operation taking out the implants