关节镜辅助下复位后经皮空心螺钉联合钢丝张力带内固定治疗髌骨粉碎性骨折的临床研究

摘要

目的 探讨关节镜辅助下复位后经皮空心螺钉联合钢丝张力带内固定治疗髌骨粉碎性骨折患者的临床效果.方法 选取2013年4月至2017年9月本院髌骨粉碎性骨折患者105例,依据治疗方案不同分为观察组(n=53)、对照组(n=52).对照组予以传统切开复位克氏针联合张力带钢丝内固定,观察组予以关节镜辅助下复位后经皮空心螺钉联合钢丝张力带内固定.比较两组手术情况、术后骨折愈合时间,术后进行1年随访,对比两组并发症发生率、手术优良率与术前、术后1年疼痛程度评分(VAS)、膝关节功能评分(HSS)、日常生活能力评分(ADL)、生活质量评分(SF-36).结果 观察组术中透视次数较对照组少,手术切口长度、术后骨折愈合时间较对照组短(P＜0.05);观察组术后并发症发生率(3.85％)低于对照组(20.00％),手术优良率(96.15％)高于对照组(82.00％)(P＜0.05);两组术后1年VAS评分均较术前降低,且观察组低于对照组,HSS、ADL及SF-36评分均较术前提高,且观察组高于对照组(P＜0.05).结论 髌骨粉碎性骨折患者予以关节镜辅助下复位后经皮空心螺钉联合钢丝张力带内固定治疗可减轻手术创伤,加速患者康复,降低并发症发生率,减轻疼痛感,提高膝关节功能、日常生活能力及生活质量,效果显著.%Objective To investigate the clinical effect of percutaneous hollow screw combined with tension band internal fixation for comminuted patellar fracture after arthroscopic reduction.Methods 105 patients with comminuted patellar fracture in our hospital from April 2013 to September 2017 were selected and divided into observation group (n =53) and control group (n =52) according to different treatment schemes.The control group was treated with conventional open reduction and Kirschner wire combined with tension band internal fixation,while the observation group was treated with arthroscopic assisted reduction and percutaneous cannulated screw combined with wire tension band internal fixation.The operation status and postoperative fracture healing time of the two groups were compared.One-year follow-up was performed after operation.The incidence of complications,the excellent and good rate of operation,and the preoperative and postoperative pain scores (VAS) and knee were compared.Hospital for special surgery knee score (HSS),Activity of Daily Life Scale (ADL),quality of life score (the Mos 36-item Short Form Health Survey,SF-36) were compared.Results The observation group had fewer fluoroscopy times during operation,shorter incision length and shorter healing time after operation than the control group (P ＜ 0.05);the incidence of complications in the observation group was 3.85％,lower than 20.00％ in the control group,and the excellent and good rate of operation was 96.15％,higher than 82.00％ in the control group (P ＜ 0.05);the VAS scores of the two groups were lower than those of the control group one year after operation,and the scores of HSS,ADL and SF-36 were lower than those of the control group.The preoperative improvement was higher in the observation group than in the control group (P ＜ 0.05).Conclusions Arthroscopic reduction combined with percutaneous hollow screw and tension band internal fixation for patellar comminuted fracture can reduce surgical trauma and accelerate the rehabilitation of patients.It can reduce the incidence of complications,relieve pain,improve knee function,daily living ability and quality of life,and the effect is remarkable.