新型复位方法空心拉力螺钉内固定治疗髌骨骨折的临床观察
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摘要
目的：通过对2009~2011年骨伤科收治的100例髌骨骨折的病人进行调查与分析，介绍横行及粉碎性髌骨骨折的一种新型复位方法，即横行骨折应用髌骨复位钳闭合复位，粉碎性骨折应用髌内侧切口翻转显露髌骨关节面直视复位，并应用空心拉力螺钉内固定治疗髌骨骨折；对比评价该方法的优缺点，为临床治疗提供参考依据及指导。
方法：以2009年~2011年河北医科大学第三医院骨伤科收治的100例髌骨骨折的住院病人为研究对象，其中横形骨折53例，粉碎性骨折47例，横行骨折组采用闭合复位空心拉力螺钉固定18例，开放复位克氏针张力带内固定35例；粉碎性骨折组采用翻转复位空心拉力螺钉固定17例，开放复位克氏针张力带固定30例。手术方法：①横行骨折闭合复位空心拉力螺钉固定组:在C形臂X光机透视下，以髌骨复位钳复位骨折，透视正侧位，见骨折对位满意，关节面平整后扣紧复位钳，屈膝约40°自髌骨上极平行打入定位导针3枚，两枚导针位于髌骨前侧即张力受力侧，中间一枚导针位于正中心压力侧。透视下见导针位置良好后，测深，旋入直径4.0mm的空心拉力螺钉，螺钉长度以头部部刚穿透对侧皮质为宜。关节面在操作过程中保持平整。拔除导针，冲洗伤口，以苯扎氯铵贴覆盖伤口。②横行骨折开放复位克氏针张力带内固定组：取髌前弧形切口，切开骨折端周围髌前腱膜，显露骨折端，清理断端后取髌骨复位钳以髌骨前面为解剖标志复位骨折，必要时切开髌旁支持结构以手指辅助复位及探查关节面是否平整。C形臂X光机透视下检查髌骨关节面平整后，自髌骨下极向髌骨上极平行穿入2根2mm粗克氏针，于每根克氏针头尾部分别用18号钢丝缠绕一周后拧紧，髌骨底部打结。③粉碎性骨折翻转复位空心拉力螺钉固定组：取膝内侧髌旁弧形切口，显露髌内侧支持带，自髌骨旁0.5~1.0厘米处切开髌内侧支持带，伸膝状态下翻转髌骨90°，显露髌骨关节面，清理断端，直视下复位髌骨关节面，关节面平整后以髌骨复位钳临时固定骨块，用导针垂直于骨折线固定各骨折块，测深后开口骨皮质，拧入合适长度的直径4.0mm空心拉力螺钉固定骨折块。螺钉数目视骨块多少决定，需保证较大骨块已全部固定。固定完成后视骨折固定的牢固程度，必要时附加空心钉内张力带，或钢丝环扎。固定完成后，严密止血并修补髌内侧支持结构。④粉碎性骨折开放复位克氏针张力带内固定组：取髌前弧形切口，游离髌前皮瓣，切开髌前腱膜，显露骨折端，清理断端后取髌骨复位钳以髌骨前面为解剖标志复位骨折，并联合膝内侧支持带探查切口以手指辅助复位并探查关节面是否平整，C形臂X光机透视下检查髌骨关节面平整后，自髌骨底至髌骨尖穿入2根2mm粗克氏针，视骨折块位置克氏针或平行或交叉，克氏针位置需穿过主要骨块，于每根克氏针头尾部分别用18号钢丝绕一周后拧紧，髌骨底部打结。固定完成后视牢固程度必要时以钢丝环扎辅助固定，缝合髌前腱膜。对横行骨折组及粉碎性骨折组分别计算、分析两种治疗方法的切口长度、手术时间、术后3个月骨折的愈合率及术后6个月膝关节功能优良率。并应用SPSS15.0统计软件进行统计学分析，手术时间及切口长度利用两样本均数的t检验；术后3个月骨折愈合率及术后膝关节功能优良率利用四格表资料的χ2检验，P＜0.05为有统计学差异。比较两种治疗方法的优缺点。
结果：横行骨折组的53例病人中，空心钉内固定组切口长度及手术时间均小于克氏针张力带组；空心螺钉组术后3个月骨折愈合率高于克氏针张力带组；两种固定方法术后膝关节功能上无明显差异；在粉碎性骨折的47例病人中，空心钉内固定组切口长度及手术时间均小于克氏针张力带组；两种内固定方法在术后3个月骨折愈合率及术后膝关节功能评价上明显差异。
结论：
1翻转复位空心螺钉拉力固定技术在治疗髌骨粉碎性骨折中具有切口短，手术时间短的优点，愈合速度及膝关节功能与克氏针张力带技术相似。
2闭合复位空心拉力螺钉固定技术在治疗髌骨横行骨折中具有明显优势：创伤小，手术时间短，愈合时间短，术后膝关节功能优良。
3空心拉力螺钉在髌骨骨折的治疗中，效果确切，值得临床推广。
Objectives: Introduce the reduction and internal fixation technology ofthe patella fracture with cannulated screws, wih the ivestigation and analysisof100cases of patellar fracture patients which were treated by Orthopedicsand Traumatology Department2009-2011.Evaluate the advantages anddisadvantages of cannulated screws fixation of patellar fracture comparatively.Provide reference and guidance for the clinical treatment.
Methods: Admitted to the100cases of patella fracture inpatients whichwere treated in Orthopedics and Traumatology Ward of theThird Hospital ofHebei Medical University2009-2011.including transverse fracture53cases(cannulated screws group18cases,Kirschner’s wire tension band group35cases), comminuted fracture47cases(cannulated screws group17cases,Kirschner’s wire tension band group30cases).
1closed reduction and cannulated screw fixation in transverse fracturesgroup:reset the fracture with the reset clamp, under the perspective of theX-ray machine.Fast the reset clamp after the articular surface is satisfied.Flexthe knee40°, position the three guide pins from the patella on the pole, thetwo guide pin is located in the patella tension by the force side, the middle ofthe guide pin in the center of the pressure.Then measure the depth,length ofthe screw is appropriate when the screw head just penetrate the contralateralcortex of the bone.Pull out the guide pin,and dress the wounds withBand-Aids.
2Open reduction and cannulated screw fixation in transverse fractures group：Cut the skin with curved incision in the prepatellar, then expose the fracturefragments.Reset the fracture with the mark of the front surface of thepatella,reset the fracture with fingers necessarily.After checking the patellar articular surface is satisfied, penetrate two Kirschner wires in diameter of2mm since the end of the patella to the tip. Wrapped around each Kirschnerwire circle,with the wire. Tie the knot in the end of the patella.
3Reversed reduction and cannulated screw fixation in comminuted fracturesgroup:Cut the skin with curved incision in the medial.Cut the medial patellarretinaculum,and reset the articular surface under the eye observation.Fix eachfracture fragment to the direction of the center.After measuring thedepth,Screw the cannulated screws.Bone quantity,decided the number of thescrew.The larger bone fragments must have been fixed.The strong degree ofthe decision decide whether the secondary fixation is necessary. Repair themedial patellar retinaculum,after the fixion is completed.
4Open reduction and Kirschner’s wire tension band fixation in comminutedfractures group：Cut the skin with curved incision in the prepatellar, thenexpose the fracture fragments.Reset the fracture with the mark of the frontsurface of the patella,reset the fracture with fingers necessarily.After checkingthe patellar articular surface is satisfied, penetrate two Kirschner wires indiameter of2mm since the end of the patella to the tip. Wrapped around eachKirschner wire circle,with the wire. Tie the knot in the end of the patella. TheKirschner wires should be parallel or cross,it depends on the fracture blocks'location.It must be sure that the major fractures have been fixed. Wrappedaround each Kirschner wire circle,with the wire. Tie the knot in the end of thepatella. The strong degree of the decision decide whether the secondaryfixation is necessary.
Analysis the length of the incision,the operation time, the the rate offracture healing3months after surgery and the knee function of the twotreatments in the transverse fractures group and comminuted fractures group.and applicate statistical software SPSS15.0to statistical analysis, using achi-square test to analysis the date of rate of fracture healing3months aftersurgery and the knee function, and a t test to analysis the date of the length ofthe incision and the operation time, P <0.05with a statistical significance.
Results: In the53cases of the transverse fracture group，both the lengthof the incision and the operation time in cannulated screws group are less thanKirschner’s wire tension band group; The the rate of fracture healing3monthsafter surgery of cannulated screws group is higher than Kirschner’s wiretension band group. The knee function of the two groups have no significantdifference. In the47cases of the comminuted fracture group, the length of theincision and the operation time of the cannulated screws group are both lessthan Kirschner’s wire tension band group. The rate of fracture healing3months after surgery and the knee function of the two groups have nosignificant difference.
Conclusions:
1Closed reduction and cannulated screw fixation technique has obviousadvantages in the treatment of patellar transverse fracture：less trauma,shorter operation time, with shorter healing time, however knee function.
2Reversed reduction and cannulated screw fixation technique has theadvantages in the treatment of the comminuted patella fracture.
3New reduction method and cannulated screws internal fixation technique..
方法：以2009年~2011年河北医科大学第三医院骨伤科收治的100例髌骨骨折的住院病人为研究对象，其中横形骨折53例，粉碎性骨折47例，横行骨折组采用闭合复位空心拉力螺钉固定18例，开放复位克氏针张力带内固定35例；粉碎性骨折组采用翻转复位空心拉力螺钉固定17例，开放复位克氏针张力带固定30例。手术方法：①横行骨折闭合复位空心拉力螺钉固定组:在C形臂X光机透视下，以髌骨复位钳复位骨折，透视正侧位，见骨折对位满意，关节面平整后扣紧复位钳，屈膝约40°自髌骨上极平行打入定位导针3枚，两枚导针位于髌骨前侧即张力受力侧，中间一枚导针位于正中心压力侧。透视下见导针位置良好后，测深，旋入直径4.0mm的空心拉力螺钉，螺钉长度以头部部刚穿透对侧皮质为宜。关节面在操作过程中保持平整。拔除导针，冲洗伤口，以苯扎氯铵贴覆盖伤口。②横行骨折开放复位克氏针张力带内固定组：取髌前弧形切口，切开骨折端周围髌前腱膜，显露骨折端，清理断端后取髌骨复位钳以髌骨前面为解剖标志复位骨折，必要时切开髌旁支持结构以手指辅助复位及探查关节面是否平整。C形臂X光机透视下检查髌骨关节面平整后，自髌骨下极向髌骨上极平行穿入2根2mm粗克氏针，于每根克氏针头尾部分别用18号钢丝缠绕一周后拧紧，髌骨底部打结。③粉碎性骨折翻转复位空心拉力螺钉固定组：取膝内侧髌旁弧形切口，显露髌内侧支持带，自髌骨旁0.5~1.0厘米处切开髌内侧支持带，伸膝状态下翻转髌骨90°，显露髌骨关节面，清理断端，直视下复位髌骨关节面，关节面平整后以髌骨复位钳临时固定骨块，用导针垂直于骨折线固定各骨折块，测深后开口骨皮质，拧入合适长度的直径4.0mm空心拉力螺钉固定骨折块。螺钉数目视骨块多少决定，需保证较大骨块已全部固定。固定完成后视骨折固定的牢固程度，必要时附加空心钉内张力带，或钢丝环扎。固定完成后，严密止血并修补髌内侧支持结构。④粉碎性骨折开放复位克氏针张力带内固定组：取髌前弧形切口，游离髌前皮瓣，切开髌前腱膜，显露骨折端，清理断端后取髌骨复位钳以髌骨前面为解剖标志复位骨折，并联合膝内侧支持带探查切口以手指辅助复位并探查关节面是否平整，C形臂X光机透视下检查髌骨关节面平整后，自髌骨底至髌骨尖穿入2根2mm粗克氏针，视骨折块位置克氏针或平行或交叉，克氏针位置需穿过主要骨块，于每根克氏针头尾部分别用18号钢丝绕一周后拧紧，髌骨底部打结。固定完成后视牢固程度必要时以钢丝环扎辅助固定，缝合髌前腱膜。对横行骨折组及粉碎性骨折组分别计算、分析两种治疗方法的切口长度、手术时间、术后3个月骨折的愈合率及术后6个月膝关节功能优良率。并应用SPSS15.0统计软件进行统计学分析，手术时间及切口长度利用两样本均数的t检验；术后3个月骨折愈合率及术后膝关节功能优良率利用四格表资料的χ2检验，P＜0.05为有统计学差异。比较两种治疗方法的优缺点。
结果：横行骨折组的53例病人中，空心钉内固定组切口长度及手术时间均小于克氏针张力带组；空心螺钉组术后3个月骨折愈合率高于克氏针张力带组；两种固定方法术后膝关节功能上无明显差异；在粉碎性骨折的47例病人中，空心钉内固定组切口长度及手术时间均小于克氏针张力带组；两种内固定方法在术后3个月骨折愈合率及术后膝关节功能评价上明显差异。
结论：
1翻转复位空心螺钉拉力固定技术在治疗髌骨粉碎性骨折中具有切口短，手术时间短的优点，愈合速度及膝关节功能与克氏针张力带技术相似。
2闭合复位空心拉力螺钉固定技术在治疗髌骨横行骨折中具有明显优势：创伤小，手术时间短，愈合时间短，术后膝关节功能优良。
3空心拉力螺钉在髌骨骨折的治疗中，效果确切，值得临床推广。
Objectives: Introduce the reduction and internal fixation technology ofthe patella fracture with cannulated screws, wih the ivestigation and analysisof100cases of patellar fracture patients which were treated by Orthopedicsand Traumatology Department2009-2011.Evaluate the advantages anddisadvantages of cannulated screws fixation of patellar fracture comparatively.Provide reference and guidance for the clinical treatment.
Methods: Admitted to the100cases of patella fracture inpatients whichwere treated in Orthopedics and Traumatology Ward of theThird Hospital ofHebei Medical University2009-2011.including transverse fracture53cases(cannulated screws group18cases,Kirschner’s wire tension band group35cases), comminuted fracture47cases(cannulated screws group17cases,Kirschner’s wire tension band group30cases).
1closed reduction and cannulated screw fixation in transverse fracturesgroup:reset the fracture with the reset clamp, under the perspective of theX-ray machine.Fast the reset clamp after the articular surface is satisfied.Flexthe knee40°, position the three guide pins from the patella on the pole, thetwo guide pin is located in the patella tension by the force side, the middle ofthe guide pin in the center of the pressure.Then measure the depth,length ofthe screw is appropriate when the screw head just penetrate the contralateralcortex of the bone.Pull out the guide pin,and dress the wounds withBand-Aids.
2Open reduction and cannulated screw fixation in transverse fractures group：Cut the skin with curved incision in the prepatellar, then expose the fracturefragments.Reset the fracture with the mark of the front surface of thepatella,reset the fracture with fingers necessarily.After checking the patellar articular surface is satisfied, penetrate two Kirschner wires in diameter of2mm since the end of the patella to the tip. Wrapped around each Kirschnerwire circle,with the wire. Tie the knot in the end of the patella.
3Reversed reduction and cannulated screw fixation in comminuted fracturesgroup:Cut the skin with curved incision in the medial.Cut the medial patellarretinaculum,and reset the articular surface under the eye observation.Fix eachfracture fragment to the direction of the center.After measuring thedepth,Screw the cannulated screws.Bone quantity,decided the number of thescrew.The larger bone fragments must have been fixed.The strong degree ofthe decision decide whether the secondary fixation is necessary. Repair themedial patellar retinaculum,after the fixion is completed.
4Open reduction and Kirschner’s wire tension band fixation in comminutedfractures group：Cut the skin with curved incision in the prepatellar, thenexpose the fracture fragments.Reset the fracture with the mark of the frontsurface of the patella,reset the fracture with fingers necessarily.After checkingthe patellar articular surface is satisfied, penetrate two Kirschner wires indiameter of2mm since the end of the patella to the tip. Wrapped around eachKirschner wire circle,with the wire. Tie the knot in the end of the patella. TheKirschner wires should be parallel or cross,it depends on the fracture blocks'location.It must be sure that the major fractures have been fixed. Wrappedaround each Kirschner wire circle,with the wire. Tie the knot in the end of thepatella. The strong degree of the decision decide whether the secondaryfixation is necessary.
Analysis the length of the incision,the operation time, the the rate offracture healing3months after surgery and the knee function of the twotreatments in the transverse fractures group and comminuted fractures group.and applicate statistical software SPSS15.0to statistical analysis, using achi-square test to analysis the date of rate of fracture healing3months aftersurgery and the knee function, and a t test to analysis the date of the length ofthe incision and the operation time, P <0.05with a statistical significance.
Results: In the53cases of the transverse fracture group，both the lengthof the incision and the operation time in cannulated screws group are less thanKirschner’s wire tension band group; The the rate of fracture healing3monthsafter surgery of cannulated screws group is higher than Kirschner’s wiretension band group. The knee function of the two groups have no significantdifference. In the47cases of the comminuted fracture group, the length of theincision and the operation time of the cannulated screws group are both lessthan Kirschner’s wire tension band group. The rate of fracture healing3months after surgery and the knee function of the two groups have nosignificant difference.
Conclusions:
1Closed reduction and cannulated screw fixation technique has obviousadvantages in the treatment of patellar transverse fracture：less trauma,shorter operation time, with shorter healing time, however knee function.
2Reversed reduction and cannulated screw fixation technique has theadvantages in the treatment of the comminuted patella fracture.
3New reduction method and cannulated screws internal fixation technique..
引文
1胥少汀,于学钧,刘树清,等.改良张力带钢丝固定治疗髌骨骨折的实验研究及临床应用[J].中华骨科杂志,1987,7:309-314
2肖展豪,李炜明,翁绳健等.严重粉碎性髌骨骨折手术治疗的体会[J].中国骨与关节损伤杂志,2006,21(3):231
3Goldsten S. Patellar surface strain[J]. ClinOrthop,1986,4:372-377
4Hungerford DS,Barry M.Biomechanics of the patellofemoraljoint[J].ClinOrthop,1979,10:9215
5Carpenter J E, Kasman RA, Patel N, et al. Biomechanical evaluation ofcurrent patella f racture fixation techniques[J]. Orthop Trauma,1997,11:351
6胥少汀,于学钧,刘树清等.改良张力带钢丝内固定治疗髌骨骨折的实验研究及临床应用[J].中华骨科杂志,1987,7:309
7王一农，温鹏，王以进等.空心加压螺钉治疗髌骨骨折的生物力学研7及临床应用[J].河北医药,2002,7:24(7):541-543
8Scapinelli R. Blood supply of the human pattlla. Its relation to ischemicnecrosis after fracture[J]. Bone Jiont Surg Br.1967,49(3):563-570
9于正红，蔡胥，李鉴轶等.膝关节血供三维可视化研究及其临床意义[J]。中华关节外科杂志（电子版）,2007,1(4):227-231
10胥少汀,葛宝丰,徐印坎.实用骨科学[M].人民军医出版社756-757
11陈疾忤,陈世益,张鹏.髌骨内侧支持带稳定机制的研究[J].中国运动医学杂志,2003,22(5),466-469
12董纪元,卢世璧,王继芳,等.小切口膝关节粘连松解术后及连续被动活动治疗膝关节僵直[J].中华骨科杂志,1997,17(11):675-677
13曾湘穗,冯宗权,陈宏.伸直型膝关节僵硬松解术附30例报告[J].中华骨科杂志,1996,16(1):22-24
14王振海,刘中平.髌骨骨折的远期随访观察(附48例分析)[J].中华骨科杂志,1985,5(5):277-279
15王海义,王怀甲,刘荫桂,等.股四头肌成形术治疗股骨干骨折后膝关节伸位僵直[J].中华骨科杂志,1983,3(3):141-142
16李迂俊,李宝昌,阎敬珍,等.伸膝装置粘连的手术治疗[J].中华骨科杂志,1985,5(6):359-361
1Gosal HS,Singh P,Fiel RE.Clinical experience of patella fracture fixationusing metal wire or non absorbable polyester a study of37cases[J].Injure,2001,32:129
2Koshino T. Changes in patellofemoral compressive force after anterior oranteromedial displacement of tibial tuberosity for chondromalaciapatella[J]. Chin Orthop Relat Res,1991,(226):133-138
3王云.环形加“8”字钢丝内固定治疗髌骨骨折[J].临床和实验医学杂志,2006,5(12):2065
4陆裕朴,徐来堂.部分切除术治疗髌骨横断及一端粉碎性骨折的远期疗效[J].中华骨科杂志,1985,5(5):280-282
5段圆慧，尹芸生，王东等髌骨骨折内固定方法的选择与疗效[J].中国骨与关节损伤杂志2008，23（3）:236-238
6荣国威,翟桂华,刘沂等.骨科内固定学[M].第3版.北京:人民卫生出版社,1995.390-392
7李晓阳,李悦,杨胜武等. AO空心拉力螺钉加钢丝张力带固定治疗特殊类型的髌骨骨折[J].中国骨与关节损伤杂志,2005,20(3):203
8Burvant JG,Thomas KA,AlexsanderR,et al.Evalution of methodsofinternal fixtion of transverse patella fracture:a biomechanical study[J].orthop Trauma,1994,8(2):147
9Carpenter JE,Kasman RA,Patel N,et al.biomechanical evaluation ofcurrent 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
11Smith ST,Cramer KE,Kargas DE,et al.Early complication in the operativetreatment of patella fractures[J]. Orthop Trauma,1997;11:183
12Daniel LP,Dante A,Francisco A,etal.Comparison of a technique using anew percutaneous osteosynthesis device with conventional open surgeryfor displace fractures in a randomized controlled trial[J]. Orthop-Trauma,2006,20:529
13汤晓正.五角网缝合术治疗髌骨骨折[J].中国矫形外科杂志,2004,12(7):554-555
14胥少汀,葛宝丰,徐印坎.实用骨科学[M].第2版.北京:人民军医出版社,2004.702
15Levack B, Flannagan JP, Hobbs S, et al. Results of surgical treatment ofpatella fratures [J].Bone and Joint Surgery,1985,2(67):416-419
16Kesemenli CC, Subaoi M, Kirkg z T, et al. The middle period outcome ofpartial patellectomy for the treatment of comminuted patella fractures[J].Ulus Trauma Derg,2001,7(2):117-121
17胡仲云,宋小强.髌骨部分切除伸膝装置重建术治疗髌骨上、下极粉碎性骨折[J].创伤外科杂志,2004,6(2):140
2肖展豪,李炜明,翁绳健等.严重粉碎性髌骨骨折手术治疗的体会[J].中国骨与关节损伤杂志,2006,21(3):231
3Goldsten S. Patellar surface strain[J]. ClinOrthop,1986,4:372-377
4Hungerford DS,Barry M.Biomechanics of the patellofemoraljoint[J].ClinOrthop,1979,10:9215
5Carpenter J E, Kasman RA, Patel N, et al. Biomechanical evaluation ofcurrent patella f racture fixation techniques[J]. Orthop Trauma,1997,11:351
6胥少汀,于学钧,刘树清等.改良张力带钢丝内固定治疗髌骨骨折的实验研究及临床应用[J].中华骨科杂志,1987,7:309
7王一农，温鹏，王以进等.空心加压螺钉治疗髌骨骨折的生物力学研7及临床应用[J].河北医药,2002,7:24(7):541-543
8Scapinelli R. Blood supply of the human pattlla. Its relation to ischemicnecrosis after fracture[J]. Bone Jiont Surg Br.1967,49(3):563-570
9于正红，蔡胥，李鉴轶等.膝关节血供三维可视化研究及其临床意义[J]。中华关节外科杂志（电子版）,2007,1(4):227-231
10胥少汀,葛宝丰,徐印坎.实用骨科学[M].人民军医出版社756-757
11陈疾忤,陈世益,张鹏.髌骨内侧支持带稳定机制的研究[J].中国运动医学杂志,2003,22(5),466-469
12董纪元,卢世璧,王继芳,等.小切口膝关节粘连松解术后及连续被动活动治疗膝关节僵直[J].中华骨科杂志,1997,17(11):675-677
13曾湘穗,冯宗权,陈宏.伸直型膝关节僵硬松解术附30例报告[J].中华骨科杂志,1996,16(1):22-24
14王振海,刘中平.髌骨骨折的远期随访观察(附48例分析)[J].中华骨科杂志,1985,5(5):277-279
15王海义,王怀甲,刘荫桂,等.股四头肌成形术治疗股骨干骨折后膝关节伸位僵直[J].中华骨科杂志,1983,3(3):141-142
16李迂俊,李宝昌,阎敬珍,等.伸膝装置粘连的手术治疗[J].中华骨科杂志,1985,5(6):359-361
1Gosal HS,Singh P,Fiel RE.Clinical experience of patella fracture fixationusing metal wire or non absorbable polyester a study of37cases[J].Injure,2001,32:129
2Koshino T. Changes in patellofemoral compressive force after anterior oranteromedial displacement of tibial tuberosity for chondromalaciapatella[J]. Chin Orthop Relat Res,1991,(226):133-138
3王云.环形加“8”字钢丝内固定治疗髌骨骨折[J].临床和实验医学杂志,2006,5(12):2065
4陆裕朴,徐来堂.部分切除术治疗髌骨横断及一端粉碎性骨折的远期疗效[J].中华骨科杂志,1985,5(5):280-282
5段圆慧，尹芸生，王东等髌骨骨折内固定方法的选择与疗效[J].中国骨与关节损伤杂志2008，23（3）:236-238
6荣国威,翟桂华,刘沂等.骨科内固定学[M].第3版.北京:人民卫生出版社,1995.390-392
7李晓阳,李悦,杨胜武等. AO空心拉力螺钉加钢丝张力带固定治疗特殊类型的髌骨骨折[J].中国骨与关节损伤杂志,2005,20(3):203
8Burvant JG,Thomas KA,AlexsanderR,et al.Evalution of methodsofinternal fixtion of transverse patella fracture:a biomechanical study[J].orthop Trauma,1994,8(2):147
9Carpenter JE,Kasman RA,Patel N,et al.biomechanical evaluation ofcurrent 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
11Smith ST,Cramer KE,Kargas DE,et al.Early complication in the operativetreatment of patella fractures[J]. Orthop Trauma,1997;11:183
12Daniel LP,Dante A,Francisco A,etal.Comparison of a technique using anew percutaneous osteosynthesis device with conventional open surgeryfor displace fractures in a randomized controlled trial[J]. Orthop-Trauma,2006,20:529
13汤晓正.五角网缝合术治疗髌骨骨折[J].中国矫形外科杂志,2004,12(7):554-555
14胥少汀,葛宝丰,徐印坎.实用骨科学[M].第2版.北京:人民军医出版社,2004.702
15Levack B, Flannagan JP, Hobbs S, et al. Results of surgical treatment ofpatella fratures [J].Bone and Joint Surgery,1985,2(67):416-419
16Kesemenli CC, Subaoi M, Kirkg z T, et al. The middle period outcome ofpartial patellectomy for the treatment of comminuted patella fractures[J].Ulus Trauma Derg,2001,7(2):117-121
17胡仲云,宋小强.髌骨部分切除伸膝装置重建术治疗髌骨上、下极粉碎性骨折[J].创伤外科杂志,2004,6(2):140