Hambright Dustin S, Walley Kempland C, Hall Amber, Appleton Paul T, Rodriguez Edward K
*Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA; and †Boston Children's Hospital, Boston, MA.
J Orthop Trauma. 2017 Feb;31(2):e66-e72. doi: 10.1097/BOT.0000000000000686.
Patella fractures with comminution, osteoporotic bone, and/or previously failed fixation are exceedingly difficult to reduce and fix. Moreover, the risk of symptomatic constructs and patients who are poorly compliant with postoperative activity restrictions can make these complex fracture patterns an even more challenging scenario. Although there is an array of techniques described for comminuted patella fractures, there lacks an accepted surgical technique for these difficult cases. In this clinical series, we describe an enhancement to the traditional tension band construct that uses additional wires and multiple tension bands to gather and fix comminuted fracture patterns in nontransverse planes, bolster osteoporotic bone, and secure fractures in patients undergoing a revision and/or have potential to be poorly compliant with postoperative activity restrictions. The clinical outcomes of 27 patients demonstrate high rates of bony union, functional range of motion, and low rates of both infection and failure. In conclusion, using the basic principles of tension band wiring remains highly versatile, useful, and economical in approaching difficult patella fractures.
伴有粉碎性骨折、骨质疏松性骨和/或既往内固定失败的髌骨骨折极难复位和固定。此外，出现症状性内固定装置的风险以及患者对术后活动限制依从性差，会使这些复杂的骨折类型成为更具挑战性的情况。尽管针对粉碎性髌骨骨折描述了一系列技术，但对于这些困难病例，仍缺乏一种被广泛接受的手术技术。在本临床系列中，我们描述了对传统张力带结构的一种改进，即使用额外的钢丝和多条张力带，以在非横断平面上聚拢并固定粉碎性骨折类型、加强骨质疏松性骨，并在接受翻修手术和/或可能对术后活动限制依从性差的患者中固定骨折。27例患者的临床结果显示骨愈合率高、功能活动范围良好，感染率和失败率低。总之，在处理困难的髌骨骨折时，运用张力带钢丝固定的基本原则仍然具有高度的通用性、实用性和经济性。
