[髌骨下极粉碎性骨折与髌腱损伤的治疗]

Zhang Yuntong, Wang Panfeng, Zhang Chuncai, Fu Qingge, Zhang Xin

Department of Orthopaedics, Affiliated Changhai Hospital of the Second Military Medical University, Shanghai 200433, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):976-9.

OBJECTIVE

To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury.

METHODS

Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3 cases had horizontal rupture of middle ligament, 1 case had oblique rupture of tibial tubercle, and 1 case had longitudinal partial rupture.

RESULTS

Healing of incision by first intention was achieved in all patients, and no complication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100 degrees in 1 patient. The fracture healing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai's criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting's criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%.

CONCLUSION

Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stability in early motion after surgery.

目的

探讨髌骨下极粉碎性骨折及髌腱损伤的治疗方法及疗效。

方法

2003年1月至2008年12月，对5例髌骨下极粉碎性骨折合并髌腱损伤患者采用镍钛聚髌器及同种异体阔筋膜移植治疗。男3例，女2例，平均年龄33.7岁（20～48岁）。受伤至手术间隔时间为1～5天。骨折程度：3例髌骨骨折3处，2例髌骨骨折4处；髌腱损伤程度：3例为髌中韧带横行断裂，1例为胫骨结节斜行断裂，1例为纵行部分断裂。

结果

所有患者切口均一期愈合，未发生感染及深静脉血栓形成等并发症。术后2天X线片显示髌骨恢复至正常高度，即髌骨高度与髌腱长度比值恢复至1∶1。5例患者平均随访18个月（10～22个月）。术后3～12周，4例患侧膝关节功能基本恢复至正常侧，1例膝关节活动范围约100°。骨折愈合时间为3～5个月。术后12～15个月取出髌骨爪，未发生复位丢失或再骨折。随访期间，未发生骨折移位、内固定松动及断裂，髌腱未再断裂。按张春才膝关节功能评定标准，优3例，良1例，可1例，优良率80%。按徐莘香膝关节功能评定标准，优2例，良2例，可1例，优良率80%。