Perry C R, McCarthy J A, Kain C C, Pearson R L
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
J Orthop Trauma. 1988;2(3):234-40. doi: 10.1097/00005131-198802030-00010.
The stability of patellar fracture fixation protected with a load-sharing cable was studied in cadavers. A transverse patellar osteotomy was produced and stabilized with standard patellar fixation with or without a figure-of-eight cable that extends from the proximal pole of the patella to the tibial tubercle. Standard fixation techniques (interfragmentary cancellous screws or modified tension-band wiring) alone failed after significantly fewer cycles of flexion and extension than did the same fixation when supplemented with a load-sharing cable. In the clinical evaluation of the load-sharing cable, 14 consecutive patients with displaced patellar fractures were treated. No immobilization was used and the patients were started on passive and active range of motion and weight-bearing ambulation in the early postoperative period. Thirteen fractures healed uneventfully. The increased stability of patellar fracture fixation protected with a load-sharing cable offers three advantages: (a) adjunctive casting is unnecessary, (b) comminuted fractures can be "pieced" together anatomically with less concern for loss of fixation, and (c) early postoperative passive and active range of motion can be achieved.
在尸体上研究了用负载分担缆线保护的髌骨骨折固定的稳定性。制作了横行髌骨截骨术，并用标准髌骨固定法进行固定，固定时使用或不使用从髌骨近端至胫骨结节的8字形缆线。单独使用标准固定技术（骨折间松质骨螺钉或改良张力带钢丝）时，在显著较少的屈伸循环次数后就失效了，而补充负载分担缆线后的相同固定方法则不然。在对负载分担缆线的临床评估中，连续治疗了14例移位髌骨骨折患者。未使用固定，患者在术后早期即开始进行被动和主动活动范围练习以及负重行走。13例骨折顺利愈合。用负载分担缆线保护的髌骨骨折固定稳定性增加有三个优点：（a）无需辅助石膏固定，（b）粉碎性骨折可以在解剖学上“拼接”在一起，而较少担心固定失效，（c）术后早期即可实现被动和主动活动范围练习。
