背景：髌骨骨折造成最重要的影响是伸膝装置连续性的断裂及潜在髌股关节的不协调。髌骨骨折手术治疗的目的是恢复髌骨关节面的平整性、维持伸膝装置的连续性、提供稳定有效的固定以便早期进行功能锻练。目的：探讨QWIX螺钉结合克氏针、钢丝置入内固定修复髌骨骨折的临床效果。方法：2011年9月至2012年9月重庆医科大学附属第一医院采用QWIX螺钉结合克氏针、钢丝置入内固定修复髌骨骨折30例，男17例，女13例，平均年龄47.7岁。术中根据骨折的粉碎情况及移位程度分别采用QWIX螺钉或QWIX螺钉+张力带钢丝或QWIX螺钉+克氏针+张力带钢丝的方式进行内固定，术后第1天允许患者进行膝关节主、被动屈伸锻炼，无附加外固定。术后6周、3个月、6个月、12个月、1年进行门诊随访，明确患者骨折愈合情况，有无并发症发生，测量双侧膝关节屈伸活动范围，术后1年应用Bostman评分对患侧膝关节功能进行评估。结果与结论：所有患者均获得随访，随访时间12-24个月。24例于术后3个月内愈合，6例于术后4个月内愈合，平均骨折愈合时间为3.2个月。随着时间的延长，患者膝关节屈伸范围不断增加，术后1年患者膝关节功能均恢复至伤前水平。随访期间1例患者因克氏针松动引起膝关节疼痛不适，其余患者无感染、膝关节疼痛、内固定失效、膝关节屈伸功能障碍等并发症发生。根据Bostman评分标准对术后1年时患者膝关节功能进行评估，优27例，良3例，差0例，优良率为100%。提示QWIX螺钉结合克氏针、钢丝置入内固定修复髌骨骨折具有骨折断端持续动静态加压、允许患者早期屈伸锻炼、减少内固定相关并发症等优点，是修复髌骨骨折的有效方法。%BACKGROUND:The most important influence caused by patel ar fracture is the breakage of knee extension apparatus continuity and potential uncoordination of patel ofemoral joint. The aim of patel ar fracture surgery is to restore the smoothness of patel ar articular surface and to maintain the continuity of knee extension apparatus, to provide stable effective fixation, so as to do early functional exercises. OBJECTIVE:To evaluate the clinical effectiveness of a fixation technique for patel ar fractures using QWIX combined with Kirschner wire and wire. METHODS:From September 2011 to September 2012, 30 patients with patel ar fractures were treated using QWIX screws combined with Kirschner wire and wire in the First Affiliated Hospital of Chongqing Medical University, China. There were 17 males and 13 females, at the age of 47.7 years on average. In accordance with the situation of comminuted fracture and the degree of displacement, QWIX screws or QWIX screws+tension band wire or QWIX screws+Kirschner wire+tension band wire were used for fixation. Active and passive knee motion exercises began at 1 day after surgery, without any external fixation. At 6 weeks, 3, 6, 12 months, and 1 year after surgery, the patients were fol owed up in out-patient clinic to identify fracture healing and to make sure whether complications appeared or not. The range of flexion and extension of bilateral knee was measured. The knee function of the affected side was evaluated using Bostman score at 1 year postoperatively. RESULTS AND CONCLUSION:Al patients were fol owed up for 12 to 24 months. 24 cases were healed within 3 months after surgery, and 6 cases were healed within 4 months after surgery, with an average healing time of 3.2 months. With time prolonged, the range of flexion and extension of bilateral knee gradual y increased. The knee function of patients recovered to the level before injury at 1 year after surgery. During fol ow-up, one patient experienced knee pain due to Kirschner wire loosening. No infection, knee pain, fixation failure, or flexion dysfunction occurred in the remaining patients. In accordance with Bostman score, there were excellent in 27 cases, good in 3 cases, and poor in 0 case, with an excellent and good rate of 100%at 1 year fol owing surgery. Results data suggested that QWIX screws combined with Kirschner wire and wire fixation in repair of patel ar fracture have some advantages such as continuous dynamic and static pressure at the broken ends of the bones, early flexion and extension exercises, and reducing the fixation-related complications. It is an effective method to repair patel ar fracture.
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