Objective: To explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures.
Methods: Betweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score.
Results: All incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one ( t=-67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up.
Conclusion: Multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.
目的: 探讨多向三维钢丝环套固定治疗髌骨下极撕脱骨折的临床疗效。.
方法: 回顾分析 2015 年 1 月—2019 年 1 月收治的 22 例髌骨下极撕脱骨折患者临床资料。男 12 例，女 10 例；年龄 20～69 岁，平均 39.4 岁。致伤原因：交通事故伤 9 例，摔伤 13 例。均为单侧膝关节闭合损伤，其中 7 例髌骨周围皮肤挫伤。术前患膝关节活动度为（20.82±7.16）°（10°～35°）。受伤至手术时间 3～12 d，平均 5.9 d。术中复位髌骨下极撕脱骨折，用直径 0.8 mm 钢丝经骨折远端骨面横向环扎髌骨，分别在髌骨上极作 3 个纵向骨隧道，直径 0.8 mm 钢丝穿越骨隧道，纵向环套于环扎钢丝圈，固定髌骨上下极骨折断端；依次收紧横向和纵向环套钢丝圈；2 号肌腱缝线纵向环扎缝合髌骨予以加强。术后随访记录患膝关节活动度、骨折愈合时间和并发症发生情况，采用 Böstman 评分评估患膝关节功能。.
结果: 术后切口均Ⅰ期愈合，无切口相关并发症发生。22 例患者均获随访，随访时间 13 个月～5 年，平均 26.7 个月。骨折愈合时间 9～12 周，平均 10.9 周。末次随访时患膝关节活动度为（129.77±2.35）°（126°～135°），与术前比较差异有统计学意义（ t=−67.022， P=0.000）。Böstman 评分为 31～36 分，平均 34.3 分。随访期间无髌骨下极骨折复位丢失、钢丝断裂、内固定失效等并发症发生。.
结论: 多向三维钢丝环套固定治疗髌骨下极撕脱骨折固定可靠、有利于早期功能锻炼、并发症少，临床疗效满意。.
Keywords: Inferior patellar pole avulsion fracture; internal fixation; steel wire.