【摘要】 目的探讨关节镜辅助闭合复位导向器引导内固定治疗髌骨骨折的临床疗效。方法回顾性研究2015年4月—2019年1月四川省达州市中心医院骨科收治髌骨骨折患者94例,根据手术方式的不同分为切开组(切开复位空心钉内固定治疗,46例)和关节镜组(关节镜辅助闭合复位导向器引导内固定治疗,48例)。其中切开组男性27例,女性19例;年龄23～68岁,平均41.3岁;致伤原因:道路交通伤19例,摔伤16例,坠落伤11例。关节镜组男性28例,女性20例;年龄22～71岁,平均42.9岁;致伤原因:道路交通伤22例,摔伤18例,坠落伤8例。比较两组围手术期指标情况、并发症发生率及膝关节Lysholm评分、视觉模拟评分(VAS),以及6个月后优良率。结果关节镜组切口长度[(3.1±0.8) cm]、骨折愈合时间[(10.3±1.3)周]短于切开组[(6.6±0.8) cm、(14.9±1.9)周],差异有统计学意义(P <0.05);两组患者手术时间比较差异无统计学意义(P> 0.05)。两组术后6个月膝关节Lysholm评分升高,且关节镜组高于切开组[(81.5±6.1)分vs.(66.3±8.9)分],差异有统计学意义(P <0.05); VAS降低,且关节镜组低于切开组[(1.5±0.3)分vs.(2.8±0.9)分],差异有统计学意义(P <0.05)。两组术后并发症发生率比较差异无统计学意义(χ2=1.987,P=0.159)。关节镜组治疗6个月后的临床优良率为79.17%(38/48),高于切开组的58.70%(27/46,P <0.05)。结论关节镜辅助闭合复位导向器引导内固定治疗髌骨骨折,疗效确切,可有效改善围手术期指标,减少患者术后疼痛,改善膝关节功能,具有较高的临床应用价值。更多还原

【Abstract】 Objective To investigate the clinical effect of the treatment of patellar fracture with arthroscopy assisted closed reduction and internal fixation guided by guide device. Methods Totally 94 patients with patellar fracture who were admitted to our hospital from Apr. 2015 to Jan. 2019 were prospectively selected and divided into incision group( n = 46,open reduction and cannulated screw internal fixation) and arthroscopic group( n = 48,arthroscopy assisted closed reduction and guide device guided internal fixation) according to different surgical methods. In the incision group,there were 27 males and 19 females,with an average age of 41. 3 years( ranged 23-68 years),and the causes of injury were: 19 cases of road traffic injury,16 cases of falling injury and 11 cases of high-falling injury. In the arthroscopic group,there were 28 males and 20 females,with an average age of 42. 9 years( ranged 22-71 years),and the causes of injury were: 22 cases of road traffic injury,18 cases of falling injury and 8 cases of highfalling injury. The perioperative indexes,incidence of complications,Lysholm score,visual analogue scale( VAS)and excellent and good rate after 6 months were compared between the two groups. Results In the arthroscopic group,the incision length [( 3. 1 ± 0. 8) cm] and fracture healing time[( 10. 6 ± 1. 3) weeks] were shorter than those of the incision group[( 6. 6 ± 0. 8) cm,( 14. 9 ± 1. 9) weeks],and the difference was statistically significant( P < 0. 05). There was no significant difference in operation time between the two groups( P > 0. 05). Lysholm score of knee joint in the two groups increased at 6 months after operation,which was higher in the arthroscopic group than that in the incision group[( 81. 5 ± 6. 1) points vs.( 66. 3 ± 8. 9) points],and the difference was statistically significant( P < 0. 05). VAS was lower in the arthroscopic group than that in the incision group[( 1. 5 ± 0. 3)points vs.( 2. 8 ± 0. 9) points],and the difference was statistically significant( P < 0. 05). There was no significant difference in the incidence of postoperative complications between the two groups( χ2= 1. 987,P = 0. 159). The clinical excellent and good rate of arthroscopic group was 79%( 38/48),which was higher than that of the incision group 59%( 27/46,P < 0. 05). Conclusion The treatment of patellar fracture with arthroscopy assisted closed reduction and internal fixation guided by guiding device has a definite effect. It can effectively improve perioperative indexes,reduce postoperative pain,improve knee joint function,and does not increase the incidence of complications. It has high clinical application value.更多还原