老年髌骨骨折术后石膏外固定和早期功能锻炼疗效及并发症的对比分析

摘要

Objective To compare the efficacy and complications of plaster immobilization and early exercise in postoperative elderly patients with patella fracture.Methods The clinical data of 103 elderly patients who were diagnosed as patella fracture in our hospital from May 2006 to May 2010 were retrospectively analyzed.All 103 patients were treated by modified tension band.Fifty-one patients received postoperative plaster fixation, and fifty-two patients received early postoperative exercise.The knee function was assessed by Bostman and KOOS scale and compared between two groups.The complications of two groups were recorded.Results The patients were followed up for an average of 47 months (33-75 months).There were no significant difference in the scores of Bostman and KOOS and knee flexion between two groups (P>0.05).The incidence rate of fixation failure was significantly higher, and the incidence rate of venous thromboembolism was significantly lower in early mobilization group than that in plaster fixation group (P<0.05).There were no significant differences in the rate of infection between two groups.Conclusions The plaster immobilization and early mobilization had their own advantages and disadvantages for postoperative patella fractures in elderly.The elderly patients with comminuted fracture should receive plaster fixation.%目的 对比分析老年髌骨骨折术后石膏外固定和早期功能锻炼的疗效及并发症. 方法 回顾性分析2006年5月至 2010年5月,在我院被诊断为髌骨骨折,经改良克氏针张力带治疗的60~85岁的老年病人103例,石膏外固定组51例,术后给予石膏外固定;早期活动组52例,术后不采用支具或石膏外固定,而是早期进行功能锻炼.对2组病人的膝关节功能采用Bostman和KOOS评分进行对比分析,并对比分析术后的并发症. 结果 术后病人随访时间为33~75月(平均47月);2组间Bostman和KOOS评分、术后膝关节屈曲差异无统计学意义(P> 0.05).早期活动组内固定失败发生率显著高于石膏固定组(P<0.05),静脉血栓栓塞发生率显著低于石膏固定组(P<0.05).2组术后感染发生率差异没有统计学意义(P>0.05). 结论 老年髌骨骨折术后行早期功能锻炼和石膏外固定对病人而言,各有优劣.非粉碎性骨折、骨质较好且固定较为牢固的老年病人可优先考虑给予早期功能锻炼;粉碎性骨折而固定不牢固的老年病人可优先考虑给予石膏外固定,但有相对较高的静脉血栓发生率.