微创无头加压螺钉固定术治疗髌骨横断骨折
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摘要
目的探讨微创无头加压螺钉固定术治疗髌骨横断骨折的临床疗效。方法收集2015年3月至2017年2月收治的80例髌骨横断骨折患者为研究对象,采用随机数字表法均分为对照组及观察组各40例,对照组实施空心钉张力带微创术治疗,观察组另实施微创无头加压螺钉固定术治疗,观察两组手术相关指标(手术时间、术中出血量、骨折愈合时间)、膝关节活动(Lysholm)评分、视觉模拟疼痛评分(VAS)、术后并发症发生率及复发率。结果观察组手术时间(63.32±4.28)min、骨折愈合时间(68.09±12.21)d较对照组的(21.95±121.61)min、(5.12±77.08)d明显缩短,术中出血量(30.59±7.04)ml较对照组的(112.29±11.79)ml明显减少(P<0.01);术前两组Lysholm评分、VAS评分相较无明显差异(P>0.05);与术前相较,术后两组Lysholm评分明显升高,VAS评分明显降低,且术后观察组Lysholm评分(78.76±4.50)分、VAS评分(3.37±1.56)分明显优于对照组(P<0.05);观察组术后并发症总发生率、术后1年复发率为25.00%、2.50%较对照组的50.00%、22.50%明显低(P<0.05,P<0.01)。结论微创无头加压螺钉固定术治疗髌骨横断骨折患者的临床效果较空心钉张力带微创术更为明显,不仅可有效缩短手术及骨折愈合时间,明显减少术中出血量,且在改善患者预后效果及减轻疼痛方面作用显著。
Objective To investigate the clinical effect of minimally invasive headless compression screw fixation in the treatment of transverse patellar fracture.Methods A total of 80 patients with transverse patellar fracture who received treatment from March 2015 to February 2017 were selected and divided into control group and observation group randomly(n=40,each).The control group patients received minimally invasive surgery of hollow screw and tension band,and the observation group patients received minimally invasive headless compression screw fixation.The operation related indexes(such as operation time,intraoperative bleeding volume,fracture healing time),knee joint activity score(Lysholm score),visual analogue scale(VAS),incidence of complications and recurrence rate were observed.Results Compared with control group,the operation time,fracture healing time and intraoperative bleeding volume were fewer in observation group [(63.32±4.28)min vs(77.08±5.12)min,t=13.041,P<0.05;(68.09±12.21)d vs(121.61±21.95)d,t=13.476,P<0.01;(30.59±7.04)ml vs(112.29±11.79)ml,t=37.629,P<0.01].There were no significant differences in Lysholm socre and VAS before the treatment between two groups(P>0.05).After the surgery,the Lysholm socre was higher and VAS was lower in both group,and the Lysholm socre was higher and VAS was lower in observation group than those in control group(P<0.05).The total incidence of complications and 1-year recurrence rate in the observation group were 25.00% and 2.50% lower than those in the control group(50.00% and 22.50%,P<0.05,P<0.01).Conclusion Minimally invasive headless compression screw fixation has a better clinical effect than hollow screw and tension band in the treatment of transverse patellar fracture,which could not only effectively shorten the operation and fracture healing time,reduce intraoperative bleeding,but also improve the prognosis of patients and relieve pain.
Objective To investigate the clinical effect of minimally invasive headless compression screw fixation in the treatment of transverse patellar fracture.Methods A total of 80 patients with transverse patellar fracture who received treatment from March 2015 to February 2017 were selected and divided into control group and observation group randomly(n=40,each).The control group patients received minimally invasive surgery of hollow screw and tension band,and the observation group patients received minimally invasive headless compression screw fixation.The operation related indexes(such as operation time,intraoperative bleeding volume,fracture healing time),knee joint activity score(Lysholm score),visual analogue scale(VAS),incidence of complications and recurrence rate were observed.Results Compared with control group,the operation time,fracture healing time and intraoperative bleeding volume were fewer in observation group [(63.32±4.28)min vs(77.08±5.12)min,t=13.041,P<0.05;(68.09±12.21)d vs(121.61±21.95)d,t=13.476,P<0.01;(30.59±7.04)ml vs(112.29±11.79)ml,t=37.629,P<0.01].There were no significant differences in Lysholm socre and VAS before the treatment between two groups(P>0.05).After the surgery,the Lysholm socre was higher and VAS was lower in both group,and the Lysholm socre was higher and VAS was lower in observation group than those in control group(P<0.05).The total incidence of complications and 1-year recurrence rate in the observation group were 25.00% and 2.50% lower than those in the control group(50.00% and 22.50%,P<0.05,P<0.01).Conclusion Minimally invasive headless compression screw fixation has a better clinical effect than hollow screw and tension band in the treatment of transverse patellar fracture,which could not only effectively shorten the operation and fracture healing time,reduce intraoperative bleeding,but also improve the prognosis of patients and relieve pain.
引文
[1] 王峰,贾金领.可吸收内固定材料修复髌骨横断性骨折[J].中国组织工程研究,2016,20(8):1126-1132.
[2] 段强民,房清敏,王志刚.自制骨科导向复位钳在髌骨骨折术中应用[J].中国矫形外科杂志,2017,25(6):549-553.
[3] 郭二鹏,李宽新,李建柱,等.空心拉力钉和克氏针张力带治疗髌骨骨折疗效的Meta分析[J].吉林大学学报(医学版),2015,41(3):606-611.
[4] 颜峰,喻灿明,郑安华.空心钉张力带与克氏针张力带治疗老年性髌骨骨折的效果比较[J].重庆医学,2016,45(7):949-951.
[5] 杜元良,肖天洁,徐丛,等.关节镜辅助下无头加压螺钉固定治疗髌骨横型骨折[J].重庆医学,2015,44(24):3345-3347.
[6] 范磊,袁同洲,黄野,等.双钢缆缝扎治疗髌骨骨折疗效分析[J].海南医学,2015,26(6):867-869.
[7] 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.
[8] 桂忠山,徐晓峰,李桓毅.无头加压螺钉和锁定加压钢板在踝关节融合固定中的对比[J].中国组织工程研究,2016,20(31):4623-4629.
[9] 李金华.微创无头加压螺钉与切开空心钉联合张力带固定治疗髌骨横型骨折的效果比较[J].河南医学研究,2016,25(11):2004-2005.
[10] 王鉴顺,蔡乐益,楼溢桯,等.3D打印技术辅助下空心螺钉微创固定治疗不稳定型骨盆骨折[J].中华创伤骨科杂志,2017,19(3):240-244.
[11] 刘振伟.对比分析微创无头加压螺钉与切开空心钉联合张力带固定治疗髌骨横型骨折的疗效[J].临床医学研究与实践,2016,1(6):31.
[12] 李春江.带孔克氏针钢丝缠绕加压张力带治疗髌骨骨折疗效观察[J].中国修复重建外科杂志,2015,29(12):1466-1468.
[2] 段强民,房清敏,王志刚.自制骨科导向复位钳在髌骨骨折术中应用[J].中国矫形外科杂志,2017,25(6):549-553.
[3] 郭二鹏,李宽新,李建柱,等.空心拉力钉和克氏针张力带治疗髌骨骨折疗效的Meta分析[J].吉林大学学报(医学版),2015,41(3):606-611.
[4] 颜峰,喻灿明,郑安华.空心钉张力带与克氏针张力带治疗老年性髌骨骨折的效果比较[J].重庆医学,2016,45(7):949-951.
[5] 杜元良,肖天洁,徐丛,等.关节镜辅助下无头加压螺钉固定治疗髌骨横型骨折[J].重庆医学,2015,44(24):3345-3347.
[6] 范磊,袁同洲,黄野,等.双钢缆缝扎治疗髌骨骨折疗效分析[J].海南医学,2015,26(6):867-869.
[7] 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.
[8] 桂忠山,徐晓峰,李桓毅.无头加压螺钉和锁定加压钢板在踝关节融合固定中的对比[J].中国组织工程研究,2016,20(31):4623-4629.
[9] 李金华.微创无头加压螺钉与切开空心钉联合张力带固定治疗髌骨横型骨折的效果比较[J].河南医学研究,2016,25(11):2004-2005.
[10] 王鉴顺,蔡乐益,楼溢桯,等.3D打印技术辅助下空心螺钉微创固定治疗不稳定型骨盆骨折[J].中华创伤骨科杂志,2017,19(3):240-244.
[11] 刘振伟.对比分析微创无头加压螺钉与切开空心钉联合张力带固定治疗髌骨横型骨折的疗效[J].临床医学研究与实践,2016,1(6):31.
[12] 李春江.带孔克氏针钢丝缠绕加压张力带治疗髌骨骨折疗效观察[J].中国修复重建外科杂志,2015,29(12):1466-1468.