Massoud Elsayed Ibraheem Elsayed
Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Egypt.
Ulus Travma Acil Cerrahi Derg. 2017 Mar;23(2):150-155. doi: 10.5505/tjtes.2016.46402.
Comminuted fracture of the lower patellar pole has characteristics of both patellar fracture and avulsion of the patellar tendon. Therefore, components of both injury types should be considered during treatment. None of the traditional techniques has proven sufficient alone. Currently described is technique that incorporates principles of osteosynthesis as well as repair of the patellar tendon.
Total of 23 patients with comminuted fracture of the lower patellar pole were treated surgically and prospectively followed for 24 months.
All patients returned to pre-injury level of activities of daily living at average of fourth postoperative month. Average score on scale described by Böstman et al. was 28.1 points. All fractures united within average of 10 weeks. Patellar height was preserved. Only 4 patients, all post-menopausal, demonstrated increase in degenerative changes in patellofemoral joint.
Successful osteosynthesis of the comminuted lower patellar pole using the present technique reduces potential need for partial patellectomy, and preserves original length of the extensor mechanism. Present technique allows for immediate full weight-bearing and early, extensive rehabilitation program.
髌骨下极粉碎性骨折兼具髌骨骨折和髌腱撕脱的特点。因此，治疗过程中应同时考虑这两种损伤类型的因素。目前尚无传统技术单独应用时被证明足够有效。本文介绍一种融合了接骨术原则及髌腱修复的技术。
对23例髌骨下极粉碎性骨折患者进行手术治疗，并进行了为期24个月 的前瞻性随访。
所有患者在术后平均第4个月恢复到伤前的日常生活活动水平。Böstman等人描述的评分量表平均得分为28.1分。所有骨折平均在10周内愈合。髌骨高度得以保留。仅4例患者（均为绝经后女性）髌股关节退变改变增加。
采用本技术成功地对髌骨下极粉碎性骨折进行接骨术，减少了部分髌骨切除术的潜在需求，并保留了伸膝装置的原始长度。本技术允许立即完全负重和早期、广泛的康复计划。
