摘要
目的探讨尼斯结技术间接复位治疗髌骨横形骨折的临床疗效。方法回顾性分析2017年1月—2018年12月收治且符合选择标准的25例髌骨横形骨折患者临床资料,根据术中复位方式不同分为研究组(13例)和对照组(12例)。两组患者性别、年龄、损伤侧别、致伤原因、骨折分型、受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05)。研究组使用2号缝合线穿过股四头肌腱和髌腱以构建尼斯结,收拢缝线间接复位远端和近端骨折块,依靠尼斯结的滑动加压和自稳定功能形成髌骨前侧张力带作为临时固定;对照组则使用点状复位钳直接钳夹骨折块复位及临时固定。两组复位后均使用克氏针钛缆作终末固定。记录并比较两组患者手术时间、术中出血量、随访时间、骨折愈合时间及并发症发生情况,末次随访时根据B?stman髌骨骨折疗效评分标准评估膝关节功能。结果研究组手术时间显著少于对照组(t=-2.165,P=0.041),两组术中出血量比较差异无统计学意义(t=0.514,P=0.612)。两组患者切口均Ⅰ期愈合。患者均获随访,随访时间12~16个月,平均14.4个月,两组随访时间比较差异无统计学意义(t=-0.309,P=0.760)。对照组1例患者术后1 d出现软组织刺激症状,未予以特殊处理,术后2个月症状消失。两组患者术后12周随访时骨折均愈合,随访期间无钛缆松动、断裂及腱性组织钙化等并发症出现。末次随访时根据Bostman髌骨骨折疗效评分标准,两组评分比较差异无统计学意义(t=-0.086,P=0.932);研究组有1例80岁女性患者因股四头肌萎缩、打软腿、爬楼梯受影响等因素评定为良(27分),余24例患者均评定为优。结论尼斯结技术间接复位用于治疗髌骨横形骨折能够减少手术时间,并获得良好临床疗效。
Objective To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. Methods The clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group(n=13) and control group(n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups(P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot’s sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber’s clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time,fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the B?stman scoring criteria for efficacy in patellar fractures. Results The operation time in the trial group was significantly shorter than that in the control group(t=-2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups(t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups(t=-0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up.During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the B?stman score presented no significant difference between the two groups(t=-0.086,P=0.932). In the trial group, an 80-year-old female patient was evaluated as good(score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent.Conclusion The indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.
作者
邱耀宇
王发圣
蓝文彬
陈尧清
谢昀
QIU Yaoyu;WANG Fasheng;LAN Wenbin;CHEN Yaoqing;XIE Yun(Fujian Orthopaedics Research Institute,Department of Orthopaedic Trauma,the First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian,350005,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2021年第6期710-715,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
福建省教育厅中青年教师教育科研项目(JAT190199)
福建医科大学启航基金(2018QH1051)。
关键词
髌骨横形骨折
张力带
内固定
尼斯结
间接复位
Transverse patellar fracture
tension band
internal fixation
Nice knot
indirect reduction
