Weber M J, Janecki C J, McLeod P, Nelson C L, Thompson J A
J Bone Joint Surg Am. 1980 Mar;62(2):215-20.
To determine whether any of the commonly used wiring techniques are rigid enough to allow early motion in the treatment of transverse fracture of the patella, the patellae of twenty-five fresh cadaver knees were fractured transversely and fixed using the following techniques: circumferential wiring, tension-band wiring, Magnusson wiring, and a modification of tension-band wiring. The knees were mounted in a machine capable of measuring quadriceps force, flexion angle, and fracture separation simultaneously. The knees were extended from 90 to zero degrees by applying tension to the quadriceps tendon with the force of gravity as the only resistance, and separation of the fracture fragments was measured first with the retinaculum unrepaired and then again with the retinaculum repaired. Separation of the fracture fragments was much less with the Magnusson wiring and modified tension-band wiring than with circumferential wiring or standard tension-band wiring. The retinacular repair was found to contribute to stability; however, this seemed most important in the less rigid repairs. We concluded that if early motion is to be used in treating transverse fractures of the patella, techniques in which the wire is anchored directly in bone should be used and the retinaculum should be repaired.
为了确定任何一种常用的钢丝固定技术是否足够坚固，能够在髌骨横行骨折的治疗中允许早期活动，对25个新鲜尸体膝关节的髌骨进行横行骨折，并采用以下技术进行固定：环形钢丝固定、张力带钢丝固定、马格努森钢丝固定以及张力带钢丝固定的一种改良方法。将膝关节安装在一台能够同时测量股四头肌力量、屈曲角度和骨折间隙的机器上。通过以重力作为唯一阻力向股四头肌腱施加张力，使膝关节从90度伸展至0度，首先在未修复支持带的情况下测量骨折碎片的间隙，然后在修复支持带后再次测量。与环形钢丝固定或标准张力带钢丝固定相比，马格努森钢丝固定和改良张力带钢丝固定时骨折碎片的间隙要小得多。发现支持带修复有助于稳定性；然而，这在不太坚固的固定中似乎最为重要。我们得出结论，如果要在髌骨横行骨折的治疗中采用早期活动，应使用钢丝直接锚固于骨内的技术，并应修复支持带。
