改良垂直钢丝技术治疗髌骨下极骨折疗效分析

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摘要目的探讨改良独立垂直钢丝方法治疗髌骨下极骨折的临床疗效。方法建立改良独立垂直钢丝技术治疗髌骨下极骨折的三维模型，通过有限元方法分析改良技术的生物力学特性。评估2013年3月至2016年1月应用改良独立垂直钢丝技术治疗髌骨下极粉碎性骨折15例患者的临床效果。记录手术时间、切口长度、术后Bostman髌骨骨折功能评分、术后并发症。结果 12例患者获得完整随访，随访13～35个月，平均(21.08±6.81)个月。手术时间23～60 min，平均(42.50±12.80)min。切口长度6～12 cm，平均(7.75±1.81)cm。12例患者骨折均愈合，无内固定断裂，无感染，1例术后8个月环扎钢丝打结处出现松动。最后随访Bostman评分28～30分，平均(29.16±0.834)分。最后随访膝关节活动范围125°～135°，平均(131.25±3.1)°。结论改良独立垂直钢丝技术治疗髌骨下极粉碎性骨折有更强的生物力学强度，术后即可进行膝关节伸屈功能锻炼和完全负重行走。手术方法简单有效，手术时间更短，创伤更小，费用低廉，是治疗髌骨下极骨折较为理想的方法。

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关键词 ：髌骨下极, 骨折, 垂直钢丝

Abstract：Objective To investigate the clinical outcome of the modified vertical wire technique for the treatment of distal pole fracture of the patella.Methods A three-dimensional model of modified vertical wire for inferior pole fracture of the patella was established and then the biomechanical property of the modified technique was analyzed by finite element method.From March 2013 to January 2016，15 consecutive patients with distal pole fractures of the patella treated with modified independent vertical wire technique were enrolled in this study and then the operative parameters regarding operational time as well as incision length，postoperative complications and functional outcomes were assessed.Results In the clinical study，12 of 15 patients were followed up for 13～35 months，the mean follow-up period was (21.08±6.81)months and the mean incision length and operation time was(7.75±1.81) cm (6～12 cm) and (42.50±12.80) minutes (range，23～60 minutes).Incision infection，implant breakage，nonunion，and loss of reduction did not occur.One patient suffered loosening of the twisted knot of the cerclage wire at 8 months after operation.At the final follow-up，the mean Bostman score was (29.16±0.834) (28～30) and the average range of the knee motion arc was (131.25±3.1)°(125°～135°).Conclusion The modified independent vertical wire technique for the treatment of distal fracture of the patella is an effective，simple and minimally invasive surgery which can provide stable fixation for immediate postoperative extension and flexion exercise and early full weightbearing with lower cost of treatment and ultimately excellent functional results.

Key words： patellar inferior pole fracture separate vertical wiring

通讯作者: 赵建宁

作者简介: 何双建(1975－)，男，副主任医师，南京医科大学金陵临床医学院骨科，210002。

引用本文:

何双建 1，2，黄晓义 2，严斌 2，朱剑 2，叶峥 2，赵建宁 1*. 改良垂直钢丝技术治疗髌骨下极骨折疗效分析[J]. 实用骨科杂志, 2017, 23(11): 983-1003.
He Shuangjian 1，2，Huang Xiaoyi 2，Yan Bin 2，et al. Modified Vertical Wire Technique for the Treatment of the Patellar Distal Pole Fracture. sygkzz, 2017, 23(11): 983-1003.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I11/983

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