中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (22): 3506-3511.doi: 10.3969/j.issn.2095-4344.1278

• 组织工程骨及软骨材料 tissue-engineered bone and cartilage materials • 上一篇    下一篇

新型可吸收空心螺钉结合不可吸收缝线张力带固定治疗髌骨骨折：与传统改良张力带的对比

林奕鹏1，岳  凯2，徐盈舒2，李  棋1，黄锡豪1，李  箭1 
  

  1. 1四川大学华西医院运动医学科，四川省成都市  610041；2成都市龙泉驿区第一人民医院骨科，四川省成都市  610100
  • 收稿日期:2019-03-09
  • 通讯作者: 李棋，博士，副主任医师，四川大学华西医院骨科运动医学中心，四川省成都市 610041
  • 作者简介:林奕鹏，男，1992年生，广东省揭阳市人，汉族，2019年四川大学毕业，博士，主要从事骨科运动医学、软骨修复方面的研究。
  • 基金资助:

    四川省科技厅项目(2017SZ0017)，课题名称：全民健身运动医学与健康互动平台建设的关键技术研究与示范，项目负责人：李箭；四川大学华西医院“135”工程项目(ZY2017301) ，课题名称：膝关节脱位多发韧带损伤华西分期分型及精准诊治体系建立和应用，项目负责人：李箭

Novel absorbable cannulated screw combined with non-absorbable suture-tension band versus traditional advanced tension band for treating patellar fractures

Lin Yipeng1, Yue Kai2, Xu Yingshu2, Li Qi1, Huang Xihao1, Li Jian1
  

  1. 1Department of Sports Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China; 2Department of Orthopedics, Chengdu First People’s Hospital of Longquanyi District, Chengdu 610100, Sichuan Province, China
  • Received:2019-03-09
  • Contact: Li Qi, MD, Associate chief physician, Department of Sports Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • About author:Lin Yipeng, MD, Department of Sports Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Supported by:

    the Project of Sichuan Provincial Science and Technology Department, No. 2017SZ0017 (to LJ); the “135” Engineering Project of West China Hospital of Sichuan University, No. ZY2017301 (to LJ)

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摘要：

文章快速阅读：

 

文题释义：
髌骨骨折：是较常见的损伤，以髌骨局部肿胀、疼痛、膝关节不能自主伸直，常有皮下淤斑以及膝部皮肤擦伤为主要表现的骨折。髌骨骨折的发生年龄一般在20-50岁之间，男性多于女性，约为2∶1。临床表现为骨折后关节内大量积血，髌前皮下淤血、肿胀，严重者皮肤可发生水疱；活动时膝关节剧痛，有时可感觉到骨擦感；有移位的骨折，可触及骨折线间隙。
髌骨骨折治疗：治疗目的包括修复重建伸膝装置、减少髌骨骨质缺损、恢复关节面的完整性以及早期开展功能锻炼。髌骨骨折的治疗方法有许多，包括：髌骨部分切除、张力带固定、改良张力带固定、钢板螺钉内固定、缝合修复、钢丝环扎、经皮切开复位内固定、全髌骨切除、关节镜辅助下的切开复位内固定。
 
 
背景：对于髌骨横行骨折的治疗，传统改良张力带有需要二次手术的风险，并且也需要较长的康复时间。同时还有报道克氏针或钢丝刺破皮肤、引起疼痛等缺点，因此对于治疗方案的改进空间较大。
目的：比较可吸收空心螺钉拉力与不可吸收缝线结合张力带固定与传统改良张力带固定治疗髌骨骨折的方法与临床疗效。
方法：回顾性分析髌骨横行骨折患者49例的临床资料，其中采用可吸收空心螺钉与不可吸收缝线结合张力带固定的患者16例(A组)，采用传统改良张力带的患者33例(B组)。所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。定量或定性比较：术后恢复正常活动时间、住院费用；术后第1天、3个月、6个月膝关节正侧位X射线片；受伤前、术后6，12个月的膝关节功能评分，包括Lysholm和国际膝关节文献委员会评分。
结果与结论：①受伤前、术后6个月及术后12个月，A组、B组组内在Lysholm评分和国际膝关节文献委员会评分上差异均有显著性意义(P < 0.001)；术后6个月，A组评分显著高于B组(P < 0.001)；术后12个月2组之间差异无显著性意义(P > 0.05)；②B 组患者恢复日常活动所需时间长于 A 组(P=0.03)；③A组患者平均医疗费用为人民币7 833元(8 000-10 000元)，B组2次手术费用总和平均为11 769元(10 000-20 000元)，B 组显著高于A组(P < 0.05)；④2组患者术后第1天复查X射线片示骨折端对位、对线良好无明显错位，髌骨关节面光滑平整；A组术后3个月X射线片示骨折线模糊，钉帽模糊可见；术后6个月X射线片示骨折线消失，钉帽不可见。B组术后3个月X射线片示有克氏针及钢丝脱离的发生；⑤提示相对于传统改良张力带，新型可吸收空心螺钉与不可吸收缝线张力带在固定治疗髌骨骨折上能取得更好的疗效，可作为未来一种替代的手术方式。

关键词: 髌骨骨折, 可吸收空心螺钉, 不可吸收缝线, 内固定, 改良张力带, 生物力学, 骨折线

Abstract:

BACKGROUND: For transverse patella fractures, traditional advanced tension band possesses the risk for secondary surgery, which needs long-term rehabilitation. Kirschner wire or steel wire may pierce the skin and cause pain, so the treatment scheme needs to be improved.
OBJECTIVE: To compare the clinical efficacy of absorbable cannulated screw combined with non-absorbable suture-tension band and traditional advanced tension band for treating patella fractures.
METHODS: Clinical data of 49 patients with transverse patella fractures were analyzed retrospectively, including 16 cases of absorbable cannulated screw combined with non-absorbable suture-tension band (group A) and 33 cases of modified traditional tension band (group B). All patients signed the informed contents, and the study was approved by the ethics committee of the hospital. The time of returning normal activity and hospitalization cost were compared. The anteroposterior and lateral film of the knee joint at postoperative 1 day, 3 and 6 months, and the Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months were compared.
RESULTS AND CONCLUSION: (1) Both groups showed improved Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months (P < 0.001). The scores at postoperative 6 months in the group A were significantly higher than those in the group B (P < 0.001). There was no significant difference in the scores at postoperative 12 months between two groups (P > 0.05). (2) The time of returning normal activity in the group B was significantly longer than that in the group A (P=0.03). (3) The average hospitalization cost in the group A was ¥7 833 (¥8 000-10 000), and ¥11 769 (¥10 000-20 000) in the group B (P < 0.05). (4) At postoperative 1 day, the X-ray films showed a good alignment and no obvious dislocation, and articular surface was smooth and flat in both groups. At postoperative 3 months, the group A showed obscure fracture line and the obscure nail cap on the X-rays. Fracture line disappeared and the nail cap was invisible in the group A at postoperative 6 months. In the group B, detachment of the wire and needle was observed at postoperative 3 months. (5) In summary, compared with the traditional advanced tension band, the novel absorbable cannulated screw combined with non-absorbable suture-tension band exerts better clinical outcomes in the treatment of transverse patellar fractures, which is considered as an alternative method.

Key words: patellar fracture, absorbable cannulated screw, non-absorbable suture, internal fixation, advanced tension band, biomechanics, fracture line

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