髌骨微型钢板与克氏针张力带内固定治疗髌骨骨折的疗效比较
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摘要
目的:探讨髌骨微型钢板与克氏针张力带内固定治疗髌骨骨折的临床疗效。方法:研究对象选取自本院2015年6月至2018年2月期间收治的髌骨骨折患者共52例,并按手术方法分为常规组与观察组(各26例),采取克氏针张力带术为常规组,采取微型钢板内固定术为观察组,比较两组患者的手术持续时间、骨折愈合时间、并发症的发生率及膝关节功能,进行分析评价。结果:观察组与常规组相比较,手术时间明显缩短(t=7.102,P <0.05);观察组与常规组相比较,术后骨折愈合时间明显缩短(t=13.127,P <0.05);观察组并发症发生率(7.69%)明显低于常规组(26.92%),差异具有统计学意义(χ2=4.28,P <0.05),观察组Bostman功能优良率(93.33%)显著优于常规组(75.55%),差异具有统计学意义(χ2=4.314,P <0.05)。结论:髌骨微型钢板内固定治疗髌骨骨折具有良好的生物力学稳定性,临床疗效显著优于克氏针张力带内固定治疗,且具有骨折愈合时间短、不良反应发生率较低等优点,在临床中的应用价值更高。
Objective: To investigate the clinical effect of patellar miniplate versus Kirschner wire tension band internal fixation in the treatment of patellar fracture. Methods: A total of 52 patients with patellar fracture who were admitted to our hospital from June 2015 to February 2018 were enrolled and divided into routine group and observation group according to the surgical method, with 26 cases in each group. The patients in the routine group underwent Kirschner wire tension band internal fixation, and those in the observation group underwent miniplate internal fixation. The time of operation, time to fracture healing, incidence of complications, and knee function were compared and analyzed between the two groups. Results: The time of operation and time to fracture healing were both significantly shorter in the observation group than in the routine group(t = 7.102, P < 0.05; t = 13.127, P <0.05).The incidence of complications and excellent and good rate of Bostman function for the observation group were7.69% and 93.33%, respectively, versus 26.92% and 75.55% for the routine group; there were significant differences in the two markers between the two groups(χ2= 4.28, P < 0.05; χ2= 4.314, P < 0.05). Conclusion: Patellar miniplate internal fixation has good biomechanical stability, which is superior to Kirschner wire tension band internal fixation in the treatment of patellar fracture. It has the advantages of short healing time and low incidence of adverse reactions, with greater application value in clinical practice.
Objective: To investigate the clinical effect of patellar miniplate versus Kirschner wire tension band internal fixation in the treatment of patellar fracture. Methods: A total of 52 patients with patellar fracture who were admitted to our hospital from June 2015 to February 2018 were enrolled and divided into routine group and observation group according to the surgical method, with 26 cases in each group. The patients in the routine group underwent Kirschner wire tension band internal fixation, and those in the observation group underwent miniplate internal fixation. The time of operation, time to fracture healing, incidence of complications, and knee function were compared and analyzed between the two groups. Results: The time of operation and time to fracture healing were both significantly shorter in the observation group than in the routine group(t = 7.102, P < 0.05; t = 13.127, P <0.05).The incidence of complications and excellent and good rate of Bostman function for the observation group were7.69% and 93.33%, respectively, versus 26.92% and 75.55% for the routine group; there were significant differences in the two markers between the two groups(χ2= 4.28, P < 0.05; χ2= 4.314, P < 0.05). Conclusion: Patellar miniplate internal fixation has good biomechanical stability, which is superior to Kirschner wire tension band internal fixation in the treatment of patellar fracture. It has the advantages of short healing time and low incidence of adverse reactions, with greater application value in clinical practice.
引文
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6 . Fortis AP, Milis Z, Kostopoulos V, et al. Experimental investigation of the tension band in fractures of the patella[J]. Injury,2002,33(6):489-493.
7 . Burvant JG, Thomas KA, Alexander R,et al. Evaluation of methods of internal fixation of transverse patella fractures:a biomechanical study[J]. Orthop Trauma,1994, 8(2):147-153.
8 . Volgas D,Dreger TK. The use of mesh plates for difficult fractures of the patella[J]. Knee Surg, 2017, 30(3):200-203.
9 . Gao S, Zhang F, Gao T,et al. A novel technique of using a miniature plate incombination with tension band wiring to treat comminuted patellar fractures[J].Medicine(Baltimore), 2018, 97(15):e0355
10 . Siljander M, Vara AD, Koueiter DM, et al. Plate osteosynthesis of patella fractures-a video case report[J]. Orthop Trauma,2017,31(suppl3):S26–27.
11 . Wurm S, Augat P, Bühren V. Biomechanical assessment of lockedplating for the fixation of patella fractures[J]. Orthop Trauma,2015,29:e305–e308.
12 . Thelen S, Betsch M, Schneppendahl J,et al. Fixation of multifragmentary patella fractures using a bilateral fixedangle plate[J]. Orthopedics, 2013, 36:e1 437-1 443.
13 . Moore Tyler B, Sampathi Bharat R, Zamorano David P,et al. Fixed angle plate fixation of comminuted patellar fractures[J].Injury, 2018, 49(6):1 203-1 207.
14 . Torchia ME, Lewallen DG. Open fractures of the patella[J].Orthop Trauma,1996, 10(6):403-409.
15 . Wild M, Eichler C, Thelen S, et al. Fixed-angle plate osteosynthesis of the patella-an alternative to tension wiring[J]. Clinical Biomechanics, 2010, 25(4):341-347.
2 . Thelen S, Betsch M, Schneppendahl J, et al. Fixation of multifragmentary patella fractures using a bilateral fixedangle plate[J]. Orthopedics 2013,36(11):1 437–1 443.
3 .周智东.髌骨骨折患者行微型钢板、张力带内固定治疗的临床疗效比较[J].临床医学研究与实践, 2017, 2(24):88-89.
4 . Siljander MP, Vara AD, Koueiter DM, et al. Novel anterior plating technique for patella fracture fixation[J]. Orthopedics,2017,40:739-743.
5 . Tian Y, Zhou F, Ji H,et al. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures[J].Clinical Orthopaedics and Related Research, 2011, 469(12):3 429-3 435.
6 . Fortis AP, Milis Z, Kostopoulos V, et al. Experimental investigation of the tension band in fractures of the patella[J]. Injury,2002,33(6):489-493.
7 . Burvant JG, Thomas KA, Alexander R,et al. Evaluation of methods of internal fixation of transverse patella fractures:a biomechanical study[J]. Orthop Trauma,1994, 8(2):147-153.
8 . Volgas D,Dreger TK. The use of mesh plates for difficult fractures of the patella[J]. Knee Surg, 2017, 30(3):200-203.
9 . Gao S, Zhang F, Gao T,et al. A novel technique of using a miniature plate incombination with tension band wiring to treat comminuted patellar fractures[J].Medicine(Baltimore), 2018, 97(15):e0355
10 . Siljander M, Vara AD, Koueiter DM, et al. Plate osteosynthesis of patella fractures-a video case report[J]. Orthop Trauma,2017,31(suppl3):S26–27.
11 . Wurm S, Augat P, Bühren V. Biomechanical assessment of lockedplating for the fixation of patella fractures[J]. Orthop Trauma,2015,29:e305–e308.
12 . Thelen S, Betsch M, Schneppendahl J,et al. Fixation of multifragmentary patella fractures using a bilateral fixedangle plate[J]. Orthopedics, 2013, 36:e1 437-1 443.
13 . Moore Tyler B, Sampathi Bharat R, Zamorano David P,et al. Fixed angle plate fixation of comminuted patellar fractures[J].Injury, 2018, 49(6):1 203-1 207.
14 . Torchia ME, Lewallen DG. Open fractures of the patella[J].Orthop Trauma,1996, 10(6):403-409.
15 . Wild M, Eichler C, Thelen S, et al. Fixed-angle plate osteosynthesis of the patella-an alternative to tension wiring[J]. Clinical Biomechanics, 2010, 25(4):341-347.