真微创！髌骨骨折经皮钢丝环扎技术

髌骨骨折通常由直接暴力引起，可能合并局部皮肤软组织损伤。对于髌骨骨折的内固定方法，包括克氏针张力带、空心钉、髌骨爪，甚至于钢板等，均广泛应用于临床。但髌骨骨折开放术后均存在较高的感染及不愈合风险。

针对上述问题，有学者对横行髌骨骨折，创新性使用经皮钢丝环扎技术，取得了良好效果，相关结果发表在2020 Injury期刊上。

Purpose（目的）

本研究旨在回顾性评估经皮钢丝环扎技术治疗老年髌骨骨折的临床疗效，并介绍该手术技术。

[Purpose: This study was to retrospectively evaluate clinical outcomes of geriatric patients with patella fracture treated by percutaneous cerclage wiring and to introduce the surgical technique.]

Methods（方法）

2009年1月至2015年12月，我院连续对57例老年34-C型髌骨骨折患者进行了闭合复位经皮钢丝环扎固定术。应用视觉模拟量表(VAS)评分、Levack评分系统、WOMAC疼痛、僵硬和功能测试表、膝关节活动范围(ROM)进行功能评估。

[Methods: From January 2009 to December 2015, fifty-seven consecutive geriatric patients of type 34-C patellar fracture underwent closed reduction and percutaneous cerclage wiring fixation in our hospital. Visual Analog Scale (VAS) score, Levack score system, WOMAC test form of pain, stiffness and function, and knee joint range of motion (ROM) were applied for functional evaluation.]

表1：患者基线资料

Results（结果）

53例患者平均随访36个月(12~82个月)。所有骨折均愈合，无伤口感染、骨折再移位或钢丝移位。术后6个月发生钢丝断裂1例。13名患者移除了内植物，9名患者在钢丝打结处存在内植物激惹，其余4名患者没有具体原因。没有患者出现术后膝关节僵硬，活动范围为128.6(110–140)。在最近一次随访中，膝关节功能的平均VAS评分为伤前87.5(65–99)和78.1(53–95)。86.8% (46/53)的患者认为恢复了80%以上的膝关节功能。Levack评分平均为10.0(6-12)，其中包括35个“优秀”评价和18个“良好”评价。WOMAC平均得分为21.3(13–37)。

[Results: Fifty-three patients were followed up for a mean period of 36 months (12 to 82 months). All fractures were unioned, no wound infection, second displacement of fracture fragment or wire migration was found. Wire breakage happened in one case at six months post-operation. Thirteen patients had hardware removed, nine cases for implant irritation at the knot and four cases for no specific reason. No patient developed postoperative knee stiffness, and range of motion was 128.6° (110–140). The average VAS score of emotional knee function was 87.5 (65–99) preinjury and 78.1 (53–95) at the last follow-up. 86.8% (46/53) patients considered that they regained more than 80% of their knee function. The average Levack score was 10.0 (6–12), which included thirty-five evaluations of “excellent” and eighteen of “good”. The average WOMAC score was 21.3 (13–37).]

表2：功能结局

图1：典型病例。63岁女性，髌骨骨折粉碎、移位

图2：手术示意图

图3：术后即时（A）及术后20月（B）影像片

图4：术后48月功能恢复情况（A），内固定取出（B）

图5：术后80个月影像片

Conclusion（结论）

经皮钢丝环扎固定技术是治疗老年患者34-C型髌骨骨折的可行选择。

[Conclusion: Percutaneous cerclage wiring fixation is a viable option for type 34-C patella fracture in geriatric patients.]

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