三种内固定方法治疗髌骨骨折的临床研究
|
摘要
目的：
本课题旨在通过对钢丝环扎、改良AO张力带以及镍钛记忆合金聚髌器三种不同内固定方法治疗髌骨骨折病例临床观察及随访追踪,了解三种内固定方法在髌骨骨折治疗过程中的生物力学特征及临床应用情况。同时为今后临床治疗髌骨骨折选择准确有效的内固定方法提供一定的理路及实践根据。
材料与方法：
自2002年5月1日到2009年10月1日,笔者于湖北省中医院及广州军区武汉总医院共收集86例髌骨骨折患者资料,均应用钢丝环扎术、改良AO张力带内固定术或NiTi记忆合金聚髌器内固定术治疗,其他治疗方法暂不在本研究范围之内。
本组86例患者中：男52例,女34例,年龄17～73岁,平均41岁；左侧48例,右侧38例；新鲜性骨折84例,陈旧性骨折2例；开放性骨折9例,闭合性骨折77例；横行骨折59例,纵行骨折8例,粉碎性骨折13例,撕脱骨折6例；合并颅脑损伤5例,胫腓骨骨折5例,股骨干骨折2例,尺骨鹰嘴骨折3例,多发骨折2例。骨折原因：骨折多由高能量损伤造成,交通事故47例,高处坠落伤22例,直接暴力打击7例,其他10例。受伤距手术时间3h～12d,平均3d。行钢丝环扎内固定术治疗24例(A组)；改良AO张力带内固定术33例(B组),NiTi记忆合金聚髌器治疗29例(C组)。86例均获得随访。
结果：
本研究范围的86例髌骨骨折患者均获得随访,时间为6个月到5年,平均2年。术后根据X线片复查所见以及患者膝关节功能恢复情况,参照上述临床疗效评价标准评定疗效。平均骨折愈合时间为12周,未发生骨折断端再移位。
1记忆合金聚髌器内固定与钢丝环扎内固定、改良AO张力带内固定比较,强度相当但稳定性好。三种内固定方法均具有良好的内固定强度和稳定性。
2行钢丝环扎内固定术组有4例因骨折碎块太小,固定失败,延长长腿石膏托外固定。改良AO张力带内固定组中有2例发生感染,经进行细菌培养+药敏试验并予以相应抗生素治疗,未影响骨质愈合；3例患者因克氏针针尾刺激皮肤,致使功能锻炼时间延搁。记忆合金聚髌器内固定组1例因髌骨上部粉碎严重,且股四头肌扩张部腱膜损伤严重,术后因聚髌器持续加压作用,致使聚髌器上支嵌入骨质,但并未涉及关节面。
结论：
1钢丝环扎、改良AO张力带和镍钛记忆合金聚髌器三种内固定方式在髌骨骨折的临床治疗上均能够起到固定骨折的效果,达到一定得优良率,符合临床治疗原则。
2改良AO张力带内固定和镍钛记忆合金聚髌器内固定在髌骨骨折治疗上疗效相当,二者均优于钢丝环扎内固定术。并且固定上符合AO的理念,力学性能优越,能为患者早期功能锻炼、减少后期并发症(尤其是老年人)的发生创造更为有利的条件,是目前治疗髌骨骨折的常用手术方法。
3镍钛记忆合金聚髌器内固定在固定确切、手术操作易于掌握、可不需行外固定、早期关节功能锻炼和恢复方面明显优于改良AO张力带和钢丝环扎内固定；改良AO张力带在关节功能恢复上也要优于钢丝环扎,其他方面相当。
同时这几种固定方式在临床具体运用时又各有其优缺点,术者应根据具体病情、骨折类型、患者经济承受能力等方面选择最理想的手术方式。
Objective:
The aim of this article is to find out the biomechanical characters and therapeutic effects of the clinical application of the values of using three different methods in internal fixation for patellar fractures by comparing the internal fixation techniques of loop steel wirewith AO tension band,'TiNi shape memory alloy' for patellar fractures through clinical observation and follow-up visitation, and then, to provide some basis of theory and practice on selecting a kind of flexible, exact and effective method of internal fixation for treating patellar fractures in clinic in the future.
Materials end Methods:
Methods The clinical information of 86 patients was gathered in Hubei Provincial Hospital of TCM and Wuhan General Hospital of Guangzhou Command from May 1,2002 to Oct 1 2009. 52 cases of male,34 cases of female, all cases age from 17 to 73 years old (average 41 years old); 48 fractures occurred in left and 38 in right.84 cases of Fresh fractures,2 cases of old fractures.9 cases was open and 77 closed. 59 cases of transverse fracture of patella, 8 cases of longitudinal fracture,13 cases of comminuted fracture, 6 cases of sleeve fracture. 5 cases combining brain trauma,5 cases combining tibiofibular fractures,2 cases combining fracture of femurl,3 cases combining fracture of cubital eagle mouth. 2 cases combining multiple fracture. Much of fractures were made by the high-energy trauma,47 cases by traffic accident,22 cases during a fall onto the knee,7 cases by a direct blow and 10 cases by other reasons. The time of operation is 3h-12d after trauma, average for 3 days. 24 cases were treated by loop steel wire (Group A),26 by AO tension band (Group B) and 32 cases were treated by NT-PC (Group 0.86 cases' follow-up were available.
Result:
The time of follow-up varied from 6 months to 5 years. average was 2 years. In clinic, X-ray after operation and the knee joint recovery were analyzed consulting the criterion to evaluate therapy effect. Average healing of fracture was 12 weeks. There were no fracture displacement.
1、Fixation intensity of the former Was a little worse than hat of the latter, but the stability of By comparing NT-PC With AO tension band and loop steel wire we found that internal the former was better. The intensity and stability of these three methods of internal fixation were good.
2、4 cases applied loop steel wire failed because fracture fragment is too serious, then patella Was sewed up and the plaster immobilization were delayed. In the group of AO tension band, drug sensitive experiment was applied and, subsequently, antibiotic was used when 2 cases caught infection. 3 cases function practice were delayed because skin were disturbed by Kirschner wire. In the group of NT-PC,1 case of comrninuted fracture were serious involving quadriceps aponeurosis were destroyed badly,result in NT-PC superior branch came into the bone of patella. However, articular surface were not destroyed fortunately.
Conclutions:
1、Loop steel wire、AO tension band and NT-PC all could set the broken bone in internal fixation for patellar fractures, reach some excellent rate and were reasonable.
2、The curative effect of AO tension band is similar to that of NT-PC in internal fixation for patellar fractures. Both AO tension band and NT-PC were better than Loop steel wire. They Meet the AO concept in the fixation for patellar fractures and had superior mechanical properties.It was useful of early function practice and reducing Late complications (especially the aged). At present, they are common method for patellar fractures.
3、NT-PC was superior to Loop steel wire and AO tension band in exact fixation、simple operations、no external fixation、early function practice and recover. AO tension band was superior to Loop steel wire in recover of functionof joint, yet there had no significant difference in other ways. All three of these methods have their own advantages andshortcomings simultaneously. The surgeon should make their best choice according to the specific conditions、the kind of fracture and the patient Affordability etc.
本课题旨在通过对钢丝环扎、改良AO张力带以及镍钛记忆合金聚髌器三种不同内固定方法治疗髌骨骨折病例临床观察及随访追踪,了解三种内固定方法在髌骨骨折治疗过程中的生物力学特征及临床应用情况。同时为今后临床治疗髌骨骨折选择准确有效的内固定方法提供一定的理路及实践根据。
材料与方法：
自2002年5月1日到2009年10月1日,笔者于湖北省中医院及广州军区武汉总医院共收集86例髌骨骨折患者资料,均应用钢丝环扎术、改良AO张力带内固定术或NiTi记忆合金聚髌器内固定术治疗,其他治疗方法暂不在本研究范围之内。
本组86例患者中：男52例,女34例,年龄17～73岁,平均41岁；左侧48例,右侧38例；新鲜性骨折84例,陈旧性骨折2例；开放性骨折9例,闭合性骨折77例；横行骨折59例,纵行骨折8例,粉碎性骨折13例,撕脱骨折6例；合并颅脑损伤5例,胫腓骨骨折5例,股骨干骨折2例,尺骨鹰嘴骨折3例,多发骨折2例。骨折原因：骨折多由高能量损伤造成,交通事故47例,高处坠落伤22例,直接暴力打击7例,其他10例。受伤距手术时间3h～12d,平均3d。行钢丝环扎内固定术治疗24例(A组)；改良AO张力带内固定术33例(B组),NiTi记忆合金聚髌器治疗29例(C组)。86例均获得随访。
结果：
本研究范围的86例髌骨骨折患者均获得随访,时间为6个月到5年,平均2年。术后根据X线片复查所见以及患者膝关节功能恢复情况,参照上述临床疗效评价标准评定疗效。平均骨折愈合时间为12周,未发生骨折断端再移位。
1记忆合金聚髌器内固定与钢丝环扎内固定、改良AO张力带内固定比较,强度相当但稳定性好。三种内固定方法均具有良好的内固定强度和稳定性。
2行钢丝环扎内固定术组有4例因骨折碎块太小,固定失败,延长长腿石膏托外固定。改良AO张力带内固定组中有2例发生感染,经进行细菌培养+药敏试验并予以相应抗生素治疗,未影响骨质愈合；3例患者因克氏针针尾刺激皮肤,致使功能锻炼时间延搁。记忆合金聚髌器内固定组1例因髌骨上部粉碎严重,且股四头肌扩张部腱膜损伤严重,术后因聚髌器持续加压作用,致使聚髌器上支嵌入骨质,但并未涉及关节面。
结论：
1钢丝环扎、改良AO张力带和镍钛记忆合金聚髌器三种内固定方式在髌骨骨折的临床治疗上均能够起到固定骨折的效果,达到一定得优良率,符合临床治疗原则。
2改良AO张力带内固定和镍钛记忆合金聚髌器内固定在髌骨骨折治疗上疗效相当,二者均优于钢丝环扎内固定术。并且固定上符合AO的理念,力学性能优越,能为患者早期功能锻炼、减少后期并发症(尤其是老年人)的发生创造更为有利的条件,是目前治疗髌骨骨折的常用手术方法。
3镍钛记忆合金聚髌器内固定在固定确切、手术操作易于掌握、可不需行外固定、早期关节功能锻炼和恢复方面明显优于改良AO张力带和钢丝环扎内固定；改良AO张力带在关节功能恢复上也要优于钢丝环扎,其他方面相当。
同时这几种固定方式在临床具体运用时又各有其优缺点,术者应根据具体病情、骨折类型、患者经济承受能力等方面选择最理想的手术方式。
Objective:
The aim of this article is to find out the biomechanical characters and therapeutic effects of the clinical application of the values of using three different methods in internal fixation for patellar fractures by comparing the internal fixation techniques of loop steel wirewith AO tension band,'TiNi shape memory alloy' for patellar fractures through clinical observation and follow-up visitation, and then, to provide some basis of theory and practice on selecting a kind of flexible, exact and effective method of internal fixation for treating patellar fractures in clinic in the future.
Materials end Methods:
Methods The clinical information of 86 patients was gathered in Hubei Provincial Hospital of TCM and Wuhan General Hospital of Guangzhou Command from May 1,2002 to Oct 1 2009. 52 cases of male,34 cases of female, all cases age from 17 to 73 years old (average 41 years old); 48 fractures occurred in left and 38 in right.84 cases of Fresh fractures,2 cases of old fractures.9 cases was open and 77 closed. 59 cases of transverse fracture of patella, 8 cases of longitudinal fracture,13 cases of comminuted fracture, 6 cases of sleeve fracture. 5 cases combining brain trauma,5 cases combining tibiofibular fractures,2 cases combining fracture of femurl,3 cases combining fracture of cubital eagle mouth. 2 cases combining multiple fracture. Much of fractures were made by the high-energy trauma,47 cases by traffic accident,22 cases during a fall onto the knee,7 cases by a direct blow and 10 cases by other reasons. The time of operation is 3h-12d after trauma, average for 3 days. 24 cases were treated by loop steel wire (Group A),26 by AO tension band (Group B) and 32 cases were treated by NT-PC (Group 0.86 cases' follow-up were available.
Result:
The time of follow-up varied from 6 months to 5 years. average was 2 years. In clinic, X-ray after operation and the knee joint recovery were analyzed consulting the criterion to evaluate therapy effect. Average healing of fracture was 12 weeks. There were no fracture displacement.
1、Fixation intensity of the former Was a little worse than hat of the latter, but the stability of By comparing NT-PC With AO tension band and loop steel wire we found that internal the former was better. The intensity and stability of these three methods of internal fixation were good.
2、4 cases applied loop steel wire failed because fracture fragment is too serious, then patella Was sewed up and the plaster immobilization were delayed. In the group of AO tension band, drug sensitive experiment was applied and, subsequently, antibiotic was used when 2 cases caught infection. 3 cases function practice were delayed because skin were disturbed by Kirschner wire. In the group of NT-PC,1 case of comrninuted fracture were serious involving quadriceps aponeurosis were destroyed badly,result in NT-PC superior branch came into the bone of patella. However, articular surface were not destroyed fortunately.
Conclutions:
1、Loop steel wire、AO tension band and NT-PC all could set the broken bone in internal fixation for patellar fractures, reach some excellent rate and were reasonable.
2、The curative effect of AO tension band is similar to that of NT-PC in internal fixation for patellar fractures. Both AO tension band and NT-PC were better than Loop steel wire. They Meet the AO concept in the fixation for patellar fractures and had superior mechanical properties.It was useful of early function practice and reducing Late complications (especially the aged). At present, they are common method for patellar fractures.
3、NT-PC was superior to Loop steel wire and AO tension band in exact fixation、simple operations、no external fixation、early function practice and recover. AO tension band was superior to Loop steel wire in recover of functionof joint, yet there had no significant difference in other ways. All three of these methods have their own advantages andshortcomings simultaneously. The surgeon should make their best choice according to the specific conditions、the kind of fracture and the patient Affordability etc.
引文
[1]王亦璁.骨与关节损伤[M].第四版.北京：人民卫生出版社,2007,1385.
[2]Carpenter JE, Kasman RA, Pate IN, et al. Biomechanical evaluation of current patellaf racturef ixa tiont echniques[J]. Orthop Trauma,1997,11 (5):351-356.
[3]李勇,王奎友,孙忠霞,等.镍钛形状记忆合金髌骨爪治疗髌骨骨折[J].骨与关节损伤杂志,2004,19(4)：251.
[4]国华,胡宏伟,侯存强.二分髌骨的关节镜下表现.[J].中国矫形外科杂志,200614(23)：1840.
[5]王金亮.髌前正中直纵切口在髌骨骨折内固定治疗中的应用[J].常州实用医学,2009,25(4)：224-225.
[6]Basarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending Genicularartery in the midvastus approach to the knee[J].Clin Orthop Relat Res,2006,451:96-100.
[7]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].第3版.北京：人民军医出版社,2008：748-750.
[8]Lin F,Makhsons M, Chang AH, et al. In vivo and noninvasive six degree of freedom patellar tracldng during voluntary knee movement[J]. Clin Biomechanics,2003,18(5),401—409.
[9]Scapinelli R:Blood supply ofthe human patella. J Bone Joim srug Br 3: 563,1967.
[10]Merchant AC, Mercer RL, Jacobsen RH, et al. Roengenographic analysis of patello-femoral congruence [J]. Bone Joing Surg. 1974,56A:1391-1396.
[11]孙沪霞,钱国正,张春才,等.镍铁—聚髌器(NT-PC)治疗髌骨骨折的生物力学特性研究[J].中华骨科杂志,1992,12(5)：361-363.
[12]Bueher WJ. Affect of Low Tmperature Phase Changes the mechanical Properties of Alloy near Composition TiNi [J]. J Apply Phys,1963,34:1475.
[13]Kennedy, JG. And Fowler, PJ. Medial and anterior instability of the knee. J. Bone and Joint Surg.1971,53A:1257-1270.
[14]Mow VC, Flatow EL, Ateshian GA. Biomechanics [A]. In:Buckwalter JA, Einhom TA Simon SR(eds). Othopaedic Basic Science[M] Springfield, IL, American Academy ofOrthopaedic Surgeons, 2000.133-146.
[15]Wendt PP, Johnson RP. A study ofquadricep sexcursion, to rque, and the effect of patellectomy on cadaver knees. J Bone and Joint Surg,1985,672A(6):726.
[16]Watking MP. Effect of patellectomy on the fonction of the quadriceps and hamstrings[J]. J Bone and Joint Surg,1983, 65A:390.
[17]Heppen stall RB, Fracture treatment and healing[M]. Listed Lord:Sanders Company.1980:759-69.
[18]Anderson L:Fractures. In Crenshaw di. ED:Campbell's Operative Orthopaedics,5th ed. St. Louis,Mosby,1971.
[19]陆伟标,东华.形态记忆合金髌骨爪治疗髌骨骨折62例分析.[J].齐齐哈尔医学院杂志,2009,9(30)：1056.
[20]蒋毅.钛镍记忆合金聚髌器与AO张力带治疗髌骨骨折的对比研究.[学位论文]吉林长春：吉林大学医学院骨科研究所,2004：18.
[21]李浩,易疆莺,吴旭东,等.镍钛记忆合金聚髌器治疗髌骨骨折[J].四川医学,2009,10(30),1583-1585.
[22]Otsuka K,Ren X. Physical metallurgy of Ti-Ni-based shape memory alloys[J]. Progress in Materials Science,2005,50:511-678.
[23]Carpenter JE, Kasman RA, Patel N,et al. Biomechanical evaluation of current patella fracture fixation techniques[J]. J Orthop Trauma,1997,11(5):351-356.
[24]Partio EK, Hirvensalo E, Bostman O, et al. Absorbable rods and screws:a new method of fixation for fractures of the olecranon[J]. Int Orthop,1992,16(3):250-254.
[25]Epps C H. Complications in orthopaedic surgery (Voll). Philadelphia:JB Lippincott Co.1978.
[26]Mitchell N, Shepard N, Healing of articular cartilage in intra-articular fractures in rabbits[J]. J Bone Joint Surg Am, 1980,62(4):628-634.
[27]程根祥,王明海,童有海,等.记忆合金聚髌器治疗髌骨骨折346例报告[J].中国临床医学,2006,13(6)：1016-1017.
[28]王亦璁.BO与AO的不同之处.骨与关节损伤杂志,2002.1(17)：3-5.
[29]邵建康,王以进等.镍钦抓髌器治疗髌骨骨折的生物力学评价与临床.医用生物力学,2002.3(17)：39-40.
[1]Kose KC, Kuru I, Maralcan G, et al. Comparison of a technique using a new percutaneous osteosynthesis device with conven-tional open surgery for displaced patella fractures[J].J Orthop Trauma,2007,1:77-78.
[2]Catalano JB, Iannacone WM, Marczyk S, et al. Open fractures of the patella:long term functional outcomeJ Orthop Trauma,1995, 39:439.
[3]Hung LK, Chan kM, Chow YN, et al. Fractured patella:operative treatment using the tension band principle. Injure,1985,16: 343.
[4]叶添文,李阳,欧阳跃平,等.医用钛缆在髌骨粉碎性骨折治疗中的应用[J].中国矫形外科杂志,2009,4：268.
[5]谢扬,郑佳坤,林本丹,等.可吸收线张力带治疗髌骨骨折.中国矫形外科杂志.2004,12(14)：1104.
[6]胡春林.髌骨骨折内同定失败19例分析.中国误诊学杂志.2001.1(1)：120.
[7]李海峰,杨玉环.髌骨骨折内固定术后效果不佳原因分析.中华实用中西医杂志,2003,3(6)：1661.
[8]Burvant JG homas KA, AlexsanderR, et al. Evalution of methods of internal fixtion of transverse patella fracture:a biome-chanical study J orthop Trauma,1994,8(2):147.
[9]Carpenter JE, Kasman RA, Patel N, et al. biomechanical evaluation of current patella fracture fixtion techniques J Orthp Trauma, 1997,11(5):351.
[10]修玉才.任先军.髌骨骨折空心拉力螺钉组合张力带固定的生物力学.中国矫形外科杂志,2001,8(4)：381.
[11]刘国辉,杨述华,杜靖远,等.可吸收螺钉与克式针张力带治疗髌 骨骨折应用选择比较[J].中国矫形外科杂志,2007,14：1059.
[12]张春才,刘植栅,高建章.髌骨内固定形态记忆整复器的设计与临床应用.中华外科杂志.1989.27：692.
[13]李贺君,王大平,倪江东.等.镍钛形状记忆合金蟹爪式聚髌器的研制及生物力学研究.中国现代手术学杂志,2002,6(2)：119.
[14]王永祥,王欢,李祝永.等.五种内固定方法治疗髌骨骨折的疗效分析.齐齐哈尔医学院学报.2003.24(9)：468.
[15]Smith ST, Cramer KE, Kargas DE, et al. Early complication in the operative treatment of patella fractures. J Oflhop Trauma, 1997; 11:183.
[16]Daniel LP, Dante A, Francisco A, et al. Comparison of a technique using a new percutaneous osteosynthesis device with conven-tional open surgery for displace fractures in a randomized controlled trial. J Orthop Trauma,2006,20:529.
[17]汤晓正.五角网缝合术治疗髌骨骨折.中国矫形外科杂志,2004,12(7)：554.
[18]陈希.可吸收手术缝线研究进展国外医学刨伤与外科基本问题分册,1995,16：204.
[19]Freudenberg S, Rewerk S, Kaess M, et al. biodegradation of absorbable sutures in body fluids and PH buffers. Eur Sur Res, 2004,36:376.
[20]Li X, Ma BT, Zhu SY. Absorbable sutures fasten treatment of patella fracture. Chinese Journal of integrated Traditional and western Medicine on Surgery,2000,6(3):191.
[21]蔡晓冰,佟大可,纪方,等.Cable-Pin系统选择性治疗髌骨骨折的疗效分析[J].中国矫形外科杂志,2009,17：411.
[22]Lauterbach HH, Kinzl L. Treatment of open patella fracture with external mini-fixator[J]. Chirnrg,1991,62:432.
[23]Liang QV, Wu JW. Fracture of the patella treated by open reduction and external compressive skeletal fixation[J]. Bone Joint Surg,1987,69:83.
[24]Ibrabim Y, Erbil O, Sabri A, et al. Application of circular external fixator under arthroseopic control in comminuted patella fractures:teehnique and early results[J]. The Journal of Trauma,2006,60:659.
[2]Carpenter JE, Kasman RA, Pate IN, et al. Biomechanical evaluation of current patellaf racturef ixa tiont echniques[J]. Orthop Trauma,1997,11 (5):351-356.
[3]李勇,王奎友,孙忠霞,等.镍钛形状记忆合金髌骨爪治疗髌骨骨折[J].骨与关节损伤杂志,2004,19(4)：251.
[4]国华,胡宏伟,侯存强.二分髌骨的关节镜下表现.[J].中国矫形外科杂志,200614(23)：1840.
[5]王金亮.髌前正中直纵切口在髌骨骨折内固定治疗中的应用[J].常州实用医学,2009,25(4)：224-225.
[6]Basarir K, Erdemli B, Tuccar E, et al. Safe zone for the descending Genicularartery in the midvastus approach to the knee[J].Clin Orthop Relat Res,2006,451:96-100.
[7]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].第3版.北京：人民军医出版社,2008：748-750.
[8]Lin F,Makhsons M, Chang AH, et al. In vivo and noninvasive six degree of freedom patellar tracldng during voluntary knee movement[J]. Clin Biomechanics,2003,18(5),401—409.
[9]Scapinelli R:Blood supply ofthe human patella. J Bone Joim srug Br 3: 563,1967.
[10]Merchant AC, Mercer RL, Jacobsen RH, et al. Roengenographic analysis of patello-femoral congruence [J]. Bone Joing Surg. 1974,56A:1391-1396.
[11]孙沪霞,钱国正,张春才,等.镍铁—聚髌器(NT-PC)治疗髌骨骨折的生物力学特性研究[J].中华骨科杂志,1992,12(5)：361-363.
[12]Bueher WJ. Affect of Low Tmperature Phase Changes the mechanical Properties of Alloy near Composition TiNi [J]. J Apply Phys,1963,34:1475.
[13]Kennedy, JG. And Fowler, PJ. Medial and anterior instability of the knee. J. Bone and Joint Surg.1971,53A:1257-1270.
[14]Mow VC, Flatow EL, Ateshian GA. Biomechanics [A]. In:Buckwalter JA, Einhom TA Simon SR(eds). Othopaedic Basic Science[M] Springfield, IL, American Academy ofOrthopaedic Surgeons, 2000.133-146.
[15]Wendt PP, Johnson RP. A study ofquadricep sexcursion, to rque, and the effect of patellectomy on cadaver knees. J Bone and Joint Surg,1985,672A(6):726.
[16]Watking MP. Effect of patellectomy on the fonction of the quadriceps and hamstrings[J]. J Bone and Joint Surg,1983, 65A:390.
[17]Heppen stall RB, Fracture treatment and healing[M]. Listed Lord:Sanders Company.1980:759-69.
[18]Anderson L:Fractures. In Crenshaw di. ED:Campbell's Operative Orthopaedics,5th ed. St. Louis,Mosby,1971.
[19]陆伟标,东华.形态记忆合金髌骨爪治疗髌骨骨折62例分析.[J].齐齐哈尔医学院杂志,2009,9(30)：1056.
[20]蒋毅.钛镍记忆合金聚髌器与AO张力带治疗髌骨骨折的对比研究.[学位论文]吉林长春：吉林大学医学院骨科研究所,2004：18.
[21]李浩,易疆莺,吴旭东,等.镍钛记忆合金聚髌器治疗髌骨骨折[J].四川医学,2009,10(30),1583-1585.
[22]Otsuka K,Ren X. Physical metallurgy of Ti-Ni-based shape memory alloys[J]. Progress in Materials Science,2005,50:511-678.
[23]Carpenter JE, Kasman RA, Patel N,et al. Biomechanical evaluation of current patella fracture fixation techniques[J]. J Orthop Trauma,1997,11(5):351-356.
[24]Partio EK, Hirvensalo E, Bostman O, et al. Absorbable rods and screws:a new method of fixation for fractures of the olecranon[J]. Int Orthop,1992,16(3):250-254.
[25]Epps C H. Complications in orthopaedic surgery (Voll). Philadelphia:JB Lippincott Co.1978.
[26]Mitchell N, Shepard N, Healing of articular cartilage in intra-articular fractures in rabbits[J]. J Bone Joint Surg Am, 1980,62(4):628-634.
[27]程根祥,王明海,童有海,等.记忆合金聚髌器治疗髌骨骨折346例报告[J].中国临床医学,2006,13(6)：1016-1017.
[28]王亦璁.BO与AO的不同之处.骨与关节损伤杂志,2002.1(17)：3-5.
[29]邵建康,王以进等.镍钦抓髌器治疗髌骨骨折的生物力学评价与临床.医用生物力学,2002.3(17)：39-40.
[1]Kose KC, Kuru I, Maralcan G, et al. Comparison of a technique using a new percutaneous osteosynthesis device with conven-tional open surgery for displaced patella fractures[J].J Orthop Trauma,2007,1:77-78.
[2]Catalano JB, Iannacone WM, Marczyk S, et al. Open fractures of the patella:long term functional outcomeJ Orthop Trauma,1995, 39:439.
[3]Hung LK, Chan kM, Chow YN, et al. Fractured patella:operative treatment using the tension band principle. Injure,1985,16: 343.
[4]叶添文,李阳,欧阳跃平,等.医用钛缆在髌骨粉碎性骨折治疗中的应用[J].中国矫形外科杂志,2009,4：268.
[5]谢扬,郑佳坤,林本丹,等.可吸收线张力带治疗髌骨骨折.中国矫形外科杂志.2004,12(14)：1104.
[6]胡春林.髌骨骨折内同定失败19例分析.中国误诊学杂志.2001.1(1)：120.
[7]李海峰,杨玉环.髌骨骨折内固定术后效果不佳原因分析.中华实用中西医杂志,2003,3(6)：1661.
[8]Burvant JG homas KA, AlexsanderR, et al. Evalution of methods of internal fixtion of transverse patella fracture:a biome-chanical study J orthop Trauma,1994,8(2):147.
[9]Carpenter JE, Kasman RA, Patel N, et al. biomechanical evaluation of current patella fracture fixtion techniques J Orthp Trauma, 1997,11(5):351.
[10]修玉才.任先军.髌骨骨折空心拉力螺钉组合张力带固定的生物力学.中国矫形外科杂志,2001,8(4)：381.
[11]刘国辉,杨述华,杜靖远,等.可吸收螺钉与克式针张力带治疗髌 骨骨折应用选择比较[J].中国矫形外科杂志,2007,14：1059.
[12]张春才,刘植栅,高建章.髌骨内固定形态记忆整复器的设计与临床应用.中华外科杂志.1989.27：692.
[13]李贺君,王大平,倪江东.等.镍钛形状记忆合金蟹爪式聚髌器的研制及生物力学研究.中国现代手术学杂志,2002,6(2)：119.
[14]王永祥,王欢,李祝永.等.五种内固定方法治疗髌骨骨折的疗效分析.齐齐哈尔医学院学报.2003.24(9)：468.
[15]Smith ST, Cramer KE, Kargas DE, et al. Early complication in the operative treatment of patella fractures. J Oflhop Trauma, 1997; 11:183.
[16]Daniel LP, Dante A, Francisco A, et al. Comparison of a technique using a new percutaneous osteosynthesis device with conven-tional open surgery for displace fractures in a randomized controlled trial. J Orthop Trauma,2006,20:529.
[17]汤晓正.五角网缝合术治疗髌骨骨折.中国矫形外科杂志,2004,12(7)：554.
[18]陈希.可吸收手术缝线研究进展国外医学刨伤与外科基本问题分册,1995,16：204.
[19]Freudenberg S, Rewerk S, Kaess M, et al. biodegradation of absorbable sutures in body fluids and PH buffers. Eur Sur Res, 2004,36:376.
[20]Li X, Ma BT, Zhu SY. Absorbable sutures fasten treatment of patella fracture. Chinese Journal of integrated Traditional and western Medicine on Surgery,2000,6(3):191.
[21]蔡晓冰,佟大可,纪方,等.Cable-Pin系统选择性治疗髌骨骨折的疗效分析[J].中国矫形外科杂志,2009,17：411.
[22]Lauterbach HH, Kinzl L. Treatment of open patella fracture with external mini-fixator[J]. Chirnrg,1991,62:432.
[23]Liang QV, Wu JW. Fracture of the patella treated by open reduction and external compressive skeletal fixation[J]. Bone Joint Surg,1987,69:83.
[24]Ibrabim Y, Erbil O, Sabri A, et al. Application of circular external fixator under arthroseopic control in comminuted patella fractures:teehnique and early results[J]. The Journal of Trauma,2006,60:659.