The Therapeutic Effect of Hollow Lag Screw Combined with Tension Band for Patellar Fracture_West China Medical Journal

Authors：

WANG Jun , WANG Tao , SHI Bo , TANG Shitian , YANG Heng , ZHANG Dingwei ,  LIU Gang

Department of Orthopedics, Mianyang Central Hospital, Sichuan 621000, P. R. China.;

Corresponding author：

LIU Gang, Email: mzy-wang-jun@163.com

Keywords：

髌骨骨折; 螺钉; 张力带; 内固定

DOI：

CNKI: 51-1356/R.20120214.1530.039

Video：

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目的　探讨空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效。方法　 2005年6月－2010年9月采用空心拉力螺钉联合钢丝张力带治疗髌骨骨折38例，男29例，女9例；年龄32～69岁，平均42.2岁。其中髌骨中份横行骨折18例，斜行骨折15例，髌骨纵行骨折3例，髌骨下极骨折2例。骨折块移位0.6～3.2 cm，平均1.7 cm。受伤至手术时间1～7 d，平均2.1 d。末次随访时评估双侧膝关节主观感受、视觉模拟评分（VAS）、患侧膝关节活动度（ROM）、Lysholm评分及影像学变化。结果　患者随访13～54个月，平均19.5个月。康复期内未出现皮肤刺痛、滑囊炎、切口延期愈合或不愈合等临床并发症。末次随访时疼痛VAS评分（1.5 ± 0.9）分，患侧膝ROM为健侧的85.2%。术后2.1～3.2个月，平均2.8个月达到临床骨性愈合。患侧Lysholm评分优27例、良8例、可1例、差2例，优良率92.1%；健侧膝关节Lysholm评分优35例、良1例、可0例、差2例，两侧比较差异无统计学意义（P＞0.05）。结论　空心拉力螺钉联合钢丝张力带治疗髌骨骨折可获得较好临床疗效，且术后循序渐进的康复锻炼是膝关节功能得到最大恢复的关键。

Citation： WANG Jun,WANG Tao,SHI Bo,TANG Shitian,YANG Heng,ZHANG Dingwei,LIU Gang. The Therapeutic Effect of Hollow Lag Screw Combined with Tension Band for Patellar Fracture. West China Medical Journal, 2012, 27(2): 230-233. doi: CNKI: 51-1356/R.20120214.1530.039 Copy

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2.	Makino A, Aponte-Tinao L, Muscolo DL, et al. Arthroscopic assisted surgical technique for treating patella fractures[J]. Arthroscopy, 2002, 18(6): 671-675.
3.	Tandogan RN, Demirors H, Tuncay CI, et al. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures[J]. Arthroscopy, 2002, 18(2): 156-162.
4.	王鹏建, 李超, 张超, 等. 髌骨骨折的分型及其临床应用[J]. 中国骨与关节损伤杂志, 2007, 22 (8): 656-658.
5.	Levack B, Flannagan JP, Hobbs S. Results of surgical treatment of patellar fractures[J]. J Bone Joint Surg(Br), 1985, 67(3): 416-419.
6.	Kumar G, Mereddy PK, Hakkalamani S, et al. Implant removal following surgical stabilization of patella fracture[J]. Orthopedics, 2010, 33(5): DOI: 10.3928/01477447-20100329-14.
7.	李阳, 欧阳跃平, 苟三怀, 等. 三种不同内固定植入物治疗髌骨粉碎性骨折的效果比较[J]. 中国组织工程研究与临床康复, 2008, 12 (4): 760-764.
8.	Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques[J]. J Orthop Trauma, 1997, 11(5): 351-356.
9.	Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws[J]. J Orthop Trauma, 1997, 11(8): 573-576.
10.	许超, 史晓林, 何滨, 等. 空心加压螺钉张力带治疗髌骨横行骨折[J]. 中国中医骨伤科杂志, 2008, 16 (9): 52-53.
11.	Reilly DT, Martens M. Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities[J]. Acta Orthop Scand, 1972, 43(2): 126-137.
12.	El-Sayed AM, Ragab RK. Arthroscopic-assisted reduction and stabilization of transverse fractures of the patella[J]. Knee, 2009, 16(1): 54-57.
13.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1982, 10(3): 150-154.
14.	Dahlkvist NJ, Mayo P, Seedhom BB.Forces during squatting and rising from a deep squat[J]. Eng Med, 1982, 11(2): 67-76.
15.	Flynn TW, Soutas-Little RW. Patellofemoral joint compressive forces in forward and backward running[J]. J Orthop Sports Phys Ther, 1995, 21(5): 277-282.
16.	Ozgüven HN, Berme N. An experimental and analytical study of impact forces during human jumping[J]. J Biomech, 1988, 21(12): 1061-1066.
17.	陈军号, 许楚才, 陶凯. 空心拉力螺钉钢丝张力带法治疗髌骨骨折[J]. 创伤外科杂志, 2010, 12 (1): 40.
18.	王健. 空心拉力钉可吸收缝线张力带法治疗髌骨骨折[J]. 临床骨科杂志, 2008, 11(1): 93.
19.	张健, 安洪, 蒋电明. 髌骨骨折内固定的生物力学研究[J]. 现代医药卫生, 2001, 17(6): 416.
20.	陈执平, 张俐, 张安祯. 不同屈膝角度下髌骨应力的生物力学研究[J]. 中国骨伤, 1997, 10(1): 12-14.

1. Hohl M. Fracture of the patella[M]. Philadelphia: JB Lippincott, 1975: 1148-1177.
2. Makino A, Aponte-Tinao L, Muscolo DL, et al. Arthroscopic assisted surgical technique for treating patella fractures[J]. Arthroscopy, 2002, 18(6): 671-675.
3. Tandogan RN, Demirors H, Tuncay CI, et al. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures[J]. Arthroscopy, 2002, 18(2): 156-162.
4. 王鹏建, 李超, 张超, 等. 髌骨骨折的分型及其临床应用[J]. 中国骨与关节损伤杂志, 2007, 22 (8): 656-658.
5. Levack B, Flannagan JP, Hobbs S. Results of surgical treatment of patellar fractures[J]. J Bone Joint Surg(Br), 1985, 67(3): 416-419.
6. Kumar G, Mereddy PK, Hakkalamani S, et al. Implant removal following surgical stabilization of patella fracture[J]. Orthopedics, 2010, 33(5): DOI: 10.3928/01477447-20100329-14.
7. 李阳, 欧阳跃平, 苟三怀, 等. 三种不同内固定植入物治疗髌骨粉碎性骨折的效果比较[J]. 中国组织工程研究与临床康复, 2008, 12 (4): 760-764.
8. Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques[J]. J Orthop Trauma, 1997, 11(5): 351-356.
9. Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws[J]. J Orthop Trauma, 1997, 11(8): 573-576.
10. 许超, 史晓林, 何滨, 等. 空心加压螺钉张力带治疗髌骨横行骨折[J]. 中国中医骨伤科杂志, 2008, 16 (9): 52-53.
11. Reilly DT, Martens M. Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities[J]. Acta Orthop Scand, 1972, 43(2): 126-137.
12. El-Sayed AM, Ragab RK. Arthroscopic-assisted reduction and stabilization of transverse fractures of the patella[J]. Knee, 2009, 16(1): 54-57.
13. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J]. Am J Sports Med, 1982, 10(3): 150-154.
14. Dahlkvist NJ, Mayo P, Seedhom BB.Forces during squatting and rising from a deep squat[J]. Eng Med, 1982, 11(2): 67-76.
15. Flynn TW, Soutas-Little RW. Patellofemoral joint compressive forces in forward and backward running[J]. J Orthop Sports Phys Ther, 1995, 21(5): 277-282.
16. Ozgüven HN, Berme N. An experimental and analytical study of impact forces during human jumping[J]. J Biomech, 1988, 21(12): 1061-1066.
17. 陈军号, 许楚才, 陶凯. 空心拉力螺钉钢丝张力带法治疗髌骨骨折[J]. 创伤外科杂志, 2010, 12 (1): 40.
18. 王健. 空心拉力钉可吸收缝线张力带法治疗髌骨骨折[J]. 临床骨科杂志, 2008, 11(1): 93.
19. 张健, 安洪, 蒋电明. 髌骨骨折内固定的生物力学研究[J]. 现代医药卫生, 2001, 17(6): 416.
20. 陈执平, 张俐, 张安祯. 不同屈膝角度下髌骨应力的生物力学研究[J]. 中国骨伤, 1997, 10(1): 12-14.

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The Therapeutic Effect of Hollow Lag Screw Combined with Tension Band for Patellar Fracture

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