关节镜下微创无头加压螺钉内固定术与髌骨针联合张力钢丝固定术治疗髌骨骨折临床研究

摘要

目的:探究关节镜下微创无头加压螺钉(HCS)内固定与髌骨针联合张力钢丝固定术治疗髌骨骨折相比传统手术的优势.方法:回顾性分析髌骨骨折患者56例,15例采用传统切开复位克氏针张力带钢丝固定术的患者为A组,18例实施关节镜下微创无头加压螺钉内固定术患者为B组,23例进行关节镜下微创髌骨针联合张力钢丝固定术患者为C组,比较三组患者手术时间、术中出血量、骨折愈合情况、关节恢复情况以及术后并发症.结果:A、B、C组手术时间分别为(79.3 ± 8.4)min、(52.2 ± 7.3)min、(61.5 ± 7.8)min,差异有统计学意义(P<0.05);A、B、C组患者术中出血量分别为(61.5±8.7)ml、(34.4±5.8)ml、(35.6±4.9)ml,B、C组患者术中出血量差异无统计学意义(P>0.05),与A组的差异有统计学意义(P<0.05);胥少汀疗效结果显示:B、C组患者膝关节功能优良率、膝关节活动优良率以及骨折复位优良率均高于A 组患者,差异有统计学意义(P<0.05),B、C组之间的疗效差异无统计学意义(P>0.05);A组4例(26.7%)患者出现术后并发症,分别为术后感染2例,内固定物脱落1例,内固定物断裂1例;B组和C组在随访期间均未出现术后并发症.结论:关节镜下微创术结合 HCS用于髌骨横型骨折、结合自折式髌骨针联合张力带钢丝内固定用于髌骨粉碎性骨折临床疗效确切,与传统手术相比手术时间短,损伤小,膝关节功能恢复快,内固定可靠,术后并发症少,值得应用.%Objective:To explore the advantages of arthroscopic minimally headless compression screw (HCS)internal fixation and patellar pin combined tension wire fixation in the treatment of patellar fracture.Meth-ods:Retrospective analysis 56 cases of patellar fracture patients,15 cases were treated with traditional open reduction and Kirschner wire fixation were selected as A group,18 cases of arthroscopic headless compression screw fixation were selected as B group,23 cases of endoscopic minimally invasive patella joint the needle combined with tension wire fixation were selected as C group,compared three groups of patients with operation time,intraoperative bleeding volume,fracture healing,joint recovery and postoperative complications.Results:The operation time of A,B,C group was(79.3 ± 8.4)min,(52.2 ± 7.3)min,(61.5 ± 7.8)min,the difference was statistically significant(P<0.05);Intraoperative blood loss of A,B,C group was(61.5 ± 8.7)ml,(34.4 ± 5.8)ml,(35.6 ± 4.9)ml,there was no sig-nificant difference between group B and group C(P>0.05),there was significant difference between group B(C) and group A(P<0.05).Weidauers effect showed:the excellent and good rate of knee joint function,knee joint movement and fracture reduction in B and C group were higher than those in A group,the difference was statistically significant(P<0.05);there was no significant difference between the B group and the C group(P>0.05);in group A,4 cases(26.7%)had postoperative complications,including 2 cases of postoperative infection,1 cases of internal fixation loss,1 cases of internal fixation fracture;no complications occurred in group B and group C during the fol-low-up period.Conclusion:Arthroscopic minimally invasive surgery combined with HCS for patellar transverse frac-tures,self folding patellar needle combined with tension band wire fixation for comminuted patellar fracture has defi-nite clinical effect.Compared with the traditional operation,the operation time is shorter,the injury is less,the knee joint function recovery is faster,the internal fixation is more reliable,and the postoperative complications are less,so it is worthy of popularization and application.