Catalano J B, Iannacone W M, Marczyk S, Dalsey R M, Deutsch L S, Born C T, Delong W G
Department of Surgery, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden 08103, USA.
J Trauma. 1995 Sep;39(3):439-44. doi: 10.1097/00005373-199509000-00007.
Seventy-nine open patella fractures in 76 patients were treated between 1986 through 1994, with an 80% incidence of multiple injuries. All were treated with irrigation and debridement, open reduction, internal fixation, and reconstruction of the extensor mechanism. In no case was a primary patellectomy performed, even with severe comminution. There were three failures of initial fixation and one asymptomatic nonunion. Average range of motion for all groups was 112 degrees, at an average follow-up of 21 months. Secondary surgical procedures were performed in 65% of knees, the majority for symptomatic hardware. To determine long-term functional outcome, a modified Hospital for Special Surgery knee score was used. At an average of 36 months, good to excellent knee scores were observed in 17 of 22 patients. We conclude that all attempts for preservation of bone substance and precise reconstruction of the extensor should be attempted, reserving total patellectomy as a salvage procedure.
1986年至1994年间，对76例患者的79例开放性髌骨骨折进行了治疗，多发伤发生率为80%。所有患者均接受了冲洗清创、切开复位、内固定以及伸肌机制重建治疗。即使骨折严重粉碎，也未进行一期髌骨切除术。初次固定失败3例，1例为无症状骨不连。所有组的平均活动范围为112度，平均随访21个月。65%的膝关节进行了二次手术，大多数是因为内固定物引起症状。为了确定长期功能结果，采用了改良的特种外科医院膝关节评分。平均36个月时，22例患者中有17例膝关节评分良好至优秀。我们得出结论，应尝试所有保留骨质和精确重建伸肌的方法，将全髌骨切除术作为挽救性手术保留。
