Tandogan Reha N, Demirors Huseyin, Tuncay Cengiz I, Cesur Necip, Hersekli Murat
Department of Orthopaedics and Traumatology, Baskent University, Ankara, Turkey.
Arthroscopy. 2002 Feb;18(2):156-62. doi: 10.1053/jars.2002.30486.
To describe a technique of arthroscopic-assisted reduction and percutaneous cannulated screw fixation for displaced patellar fractures and to present the results of 5 cases.
Case series.
Five patients (3 male, 2 female) with displaced patellar fractures treated with an arthroscopic-assisted reduction and percutaneous cannulated screw fixation were prospectively analyzed. The mean age was 53 years (range, 27 to 74 years). All fractures were fixed with at least 2 4-mm cannulated screws under arthroscopic visualization. Cerclage wiring through the cannulated screws was necessary in 2 patients with osteopenic bone. Controlled passive range of motion exercises were started on the first postoperative day. Full weight bearing with an immobilizer-type brace was allowed as tolerated. The mean follow-up was 28 months (range, 24 to 35 months). The patients were evaluated with Lysholm II scores, clinical examination, knee range of motion, thigh circumference measurements, and radiographs.
All fractures healed uneventfully. The mean Lysholm II score was 84.8 (range, 75-96). All but 1 patient regained full knee range of motion. A mean quadriceps atrophy of 0.8 cm compared with the contralateral side was seen in unilateral cases. There was no implant failure or infection.
Arthroscopic-assisted reduction and percutaneous cannulated screw fixation is appropriate for displaced transverse patellar fractures without major separation and comminution. Longitudinal or oblique fractures, even if there are more than 2 major fragments, are amenable to arthroscopic techniques, providing the fragments are large enough to be fixed with screws. This technique is minimally invasive and does not disturb the vascular supply of patella. It allows clear visualization of the reduction and stability of the fracture, and facilitates early postoperative range of motion exercises. This method is not suitable for highly comminuted fractures or transverse fractures with major separation that are accompanied by rupture of the extensor mechanism.
描述一种关节镜辅助复位及经皮空心螺钉固定治疗移位髌骨骨折的技术，并展示5例患者的治疗结果。
病例系列。
对5例采用关节镜辅助复位及经皮空心螺钉固定治疗的移位髌骨骨折患者（3例男性，2例女性）进行前瞻性分析。平均年龄53岁（范围27至74岁）。所有骨折均在关节镜直视下用至少2枚4毫米空心螺钉固定。2例骨质疏松患者需通过空心螺钉进行环扎钢丝固定。术后第一天开始进行控制性被动活动度练习。允许在耐受的情况下使用固定器型支具完全负重。平均随访28个月（范围24至35个月）。采用Lysholm II评分、临床检查、膝关节活动度、大腿周径测量及X线片对患者进行评估。
所有骨折均顺利愈合。Lysholm II评分平均为84.8（范围75 - 96）。除1例患者外，其余患者均恢复了膝关节的完全活动度。单侧病例中，患侧股四头肌萎缩程度与对侧相比平均为0.8厘米。未出现内固定失败或感染情况。
关节镜辅助复位及经皮空心螺钉固定适用于无明显分离及粉碎的移位横行髌骨骨折。纵行或斜行骨折，即使有2个以上主要骨折块，若骨折块足够大可用螺钉固定，也适合采用关节镜技术。该技术创伤小，不干扰髌骨血供。能清晰观察骨折复位及稳定性，便于术后早期进行活动度练习。此方法不适用于严重粉碎性骨折或伴有伸肌机制断裂的明显分离横行骨折。
