经皮复位空心螺钉内固定治疗髌骨纵形骨折

目的探究分析经皮复位空心螺钉固定治疗髌骨纵行骨折的临床治疗效果，以期为提高髌骨骨折临床治疗提供有效依据。方法对2010年9月—-2012年9月共8例髌骨纵行骨折患者行经皮复位空心螺钉内固定术，术后第1天，鼓励患者床上进行股四头肌主动收缩舒张训练，术后3d进行助步器辅助下部分负重，术后1周后进行无辅助全负重训练，术后4周后恢复正常行走。术后4—6周门诊复查膝关节正侧位片。术后随访9—18个月，平均12个月，并依据Lyshdm膝关节评分标准进行膝关节功能评估。结果全部患者均获随访，通过随访调查，8例患者髌骨骨折均愈合良好。较传统开放手术，此方法手术切口小、术中出血量少、患者住院时间较短及功能锻炼早，患者术后膝关节功能恢复良好。Lysholm膝关节评分为93～98分，平均95分，优良率为100％。结论对单纯髌骨纵行骨折患者行经皮复位空心螺钉内固定治疗可获得较为满意的疗效，且手术时间短，手术创伤少。避免了开放手术导致的术后伤口感染、延迟愈合、不愈合、关节粘连等相关并发症发生。基本不破坏髌骨血液供应，操作易于掌握，能促进患者早期功能锻炼，康复快，保证其预后质量，临床效果显著，值得推广。

Closed reduction and percutaneous cannulated screws fixation of vertical patellar fracture

Objective To observe the clinical effect of closed reduction and percutaneous cannulated screws fixation on vertical patellar fracture, and provide an effective basis for improving the therapeutic effects of patellar fracture. Methods Eight cases of vertical patellar fracture patients were conducted percutaneous reduction and screw fixation from September 2010 to September 2012. On the first day, muscle relaxation and contraction exercises for quadriceps were done;Partial weight-bearing gait retraining with walking aids was done 3 days after the operation;full weight-bearing exer- cises without walking aids were done one week after the operation;normal walking was recovered within 4 weeks. The anteroposterior and lateral radiographs of the knees were rechecked at outpatient in 4 to 6 weeks after the operation. The followed-up was 9- 18 months,average 12 months. The knee function was assessed according to Lysholm knee scores. Results The followed up showed that the fractures in 8 cases were all healed well. Comparing to traditional open surgery, this approach surgery was with the advantages of small incision, less intraoperative blood loss, shorter hospital stay and early functional exercise. Lysholm knee score 93 to 98 points with an average of 95 points;the good rate was 100%. Con- clusion Percutaneous reduction and cannulated screw fixation in the treatment of purely vertical patellar fracture can obtain a satisfactory result, and it may avoid complications associated with open approach, such as postoperative adhesions, infection and delayed wound healing with shorter operation time, less surgical trauma. This technique should less destroy the patellar blood supply,is easy to grasp, can promote the patients with early functional exercise and quicker recovery, and improve the prognosis, clinical effect is significant.