张力带固定与钢丝环扎治疗髌骨骨折疗效分析

使用张力带固定、钢丝环扎与丝线环扎治疗髌骨骨折共６５例，平均优良率９１．５２％，但优级疗效者张力带组是８０％，钢丝及丝线环扎组分别是５６％及５６．５％。张力带内固定术后不需石膏外固定，利于膝关节早期功能锻炼与康复，疗效明显优于其它两种疗效（ｐ＜０．０５），但术中操作要求准确细致。与钢丝环扎相比，丝线环扎荷包缝合具有可避免取出内固定的第二次手术的优点，两组疗效相似。     

Tension band sutures using a washer for a proximal humerus fracture

To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.     

可吸收线张力带缝扎固定治疗粉碎性髌骨骨折

目前广泛应用AO张力带方法固定髌骨骨折均取得了较好疗效,但对较复杂粉碎性髌骨骨折复位、固定均有一定困难[1],采用钢丝或丝线绕髌骨周围缝合方法,在固定时抽紧缝线易出现碎骨块翘起,骨折缩短、移位,关节面不平整现象,为此笔者根据生物力学原理,利用PDS11可吸收缝线张力带缝扎方法固定治疗较复杂的粉碎性髌骨骨折,取得了满意疗效,临床应用和数据分析16例如下.     

Locked tension band wiring using ring pins for patellar fractures: a method of minimising implant migration

Background

A modified K-wire attached with ring (ring pin) was used to treat a displaced patellar fracture, and the ring pin was locked with tension band wiring. The purpose of this study was to evaluate the surgical outcome of this method with respect to its procedural safety.

Methods

The authors retrospectively reviewed 36 patients treated for a displaced patellar fracture and assessed bone union, fixation failure, postoperative pain, range of motion, and incidence of hardware removal. Clinical outcome was evaluated using the Böstman scoring system. The mean follow-up period was 27 (range 13–47) months.

Results

Bony union was achieved in all patients. No fixation failure and pin migration were detected. Hardware was removed in three cases (8.3 %). Reasons for removal were pain in one case and vague discomfort in two cases. The average Böstman scores at 12 months postoperatively were 29.6, with 34 (94.4 %) patients graded as excellent. The average active flexion of the knee joint was 130.4° (range 125°–150°), with an average flexion contracture of 3° (range 0°–10°).

Conclusions

This implant could facilitate satisfactory fixation, restore the integrity of the extensor mechanism, and reduce the possibility of implant migration and implant-related discomfort.     

A new and effective tension-band braided polyester suture technique for transverse patellar fracture fixation

OBJECTIVES: Concerning the tension-band principle of internal fixation, this study aims to establish whether any difference in interfragmentary gap exists after bone-reducing forceps are released, when a recommended suture-knot technique and a new technique are tested in vitro on a purpose built machine that features a model of a transverse fracture of the patella. In addition, a standard tension-band wiring technique has also been tested as one form of control. BACKGROUND: Satisfactory compression at a fracture site reduces the risk of failure of fixation, loss of reduction (interfragmentary gap >2mm) and subsequent risks of malunion, delayed union, and ultimately non-union from excessive movement. Stainless-steel wire can provide a stable rigid construct but is associated with complications. Tension-band fixation employing a braided polyester non-absorbable suture provides a less rigid construct. However, satisfactory clinical results and fewer complications are reported. The method by which a suture is tied has an effect on initial compression provided the fracture is reduced. However, it also has an effect on the degree of fracture gap once it is subject to biomechanical distraction. METHODS: By measuring the output of a strain gauge Wheatstone bridge of a purpose built rig that had been calibrated against fracture gap and compression force, the various tension-band fixation techniques as discussed above were evaluated. RESULTS: The tension-band suture technique examined in this work (the modified Wagoner's Hitch) has been evaluated. It has quantitatively shown less fracture gap than other recognised tension-band suture and wire techniques. The results exhibit statistical significance (p<0.001). CONCLUSIONS: This evaluation study has produced quantitative and comparable data of fracture gap as observed with the model of a transverse patella fracture, for both new and established surgical techniques. The contribution this study has made to the knowledge of the subject is that a testing device similar to the one in this study may be useful in the future for conducting preliminary studies of new or established tension-band techniques. The proposed tension-band suture method tested in this dissertation provided statistically significant quantitative data, which may after further work, support its use as an alternative method in the clinical setting.     

Tension band wire for acetabular fracture fixation: a technical note

Maintaining reduction of an acetabular fracture during internal fixation is difficult. A variety of clamps can be used to facilitate reduction, but they are cumbersome and may damage the sciatic nerve. We developed a simple and cost-effective technique for provisional reduction and fixation of acetabular fractures using 2 screws and a tension band wire.     

钢丝环扎与张力带钢丝内固定治疗髌骨骨折的比较

髌骨骨折手术方式以前以钢丝环扎内固定或部分切除为主,目前以张力带钢丝内固定为主。我院1987～1998年行髌骨骨折手术638例,其中钢丝环扎内固定382例,张力带钢丝内固定217例,其他方式39例,报道如下。1　材料与方法11　病例资料　本组皆为新鲜闭合骨折。钢丝环扎内固定382例,男267例,女115例,年龄19～73岁;其中粉碎性骨折216例,占565%。张力带钢丝内固定217例,男136例,女81例,年龄20～68岁,其中粉碎性骨折119例,占548%。12　手术方式121　钢丝环扎组　非粉碎性骨折在髌骨上下骨片横形钻孔后环扎。粉碎性骨折用巾钳将骨折块复位后,用1ｍｍ钢…     

髌骨环加植骨治疗髌骨重度粉碎性骨折

<正>2007年4月~2013年4月,我科采用髌骨环加植骨治疗19例髌骨重度粉碎性骨折患者,效果满意,报道如下。1材料与方法1.1病例资料本组19例,男16例,女3例,年龄21~72岁。左侧5例,右侧14例。均为重度粉碎性骨折,骨折块压缩变形明显。伤后至手术时间为2 d~2周。1.2治疗方法硬膜外麻醉。选择髌     

改良AO张力带钢丝内固定治疗髌骨骨折

2004年8月～2006年8月,我们采用改良AO张力带内固定治疗髌骨骨折80例,取得满意疗效。 1材料与方法 1．1病例资料本组80例,男44例,女36例,年龄14～65岁。均为闭合性髌骨骨折,其中横断形40例,斜形30例,粉碎性10例。     

可吸收张力带内固定在髌骨骨折治疗中的应用

目的探讨可吸收钉和可吸收线组成的可吸收张力带内固定治疗髌骨骨折的临床疗效。方法应用可吸收张力带治疗髌骨骨折37例,术后伸直位石膏固定4～6周,拆除石膏后,功能锻炼。结果37例均获随访,时间3～36个月,骨折愈合时间2～3个月。根据Lysholm＆Gillquist膝关节评分标准：优27例,良7例,可3例,优良率92%。结论可吸收张力带内固定治疗髌骨骨折固定可靠,减少了二次手术的再损伤,最大限度恢复了关节功能。     

闭合复位空心钉张力带治疗髌骨骨折

2009年10月～2012年3月,我科对27例髌骨骨折患者采用闭合复位、中空钉结合表面钢丝张力带固定治疗,疗效优良,报道如下。1材料与方法1.1病例资料本组27例,男18例,女9例,年龄18～53岁。横断骨折21     

克氏针钢丝与髌骨针钛缆两种张力带固定治疗髌骨骨折

目的比较克氏针钢丝与髌骨针钛缆张力带固定治疗髌骨骨折的疗效。方法将128例髌骨骨折患者按固定方式分为A组(克氏针钢丝张力带固定,65例)和B组(髌骨针钛缆张力带固定,63例)。比较两组住院费用、住院天数、并发症发生率以及关节功能优良率。结果患者均获得随访,时间12~24个月。两组住院费用、住院天数、并发症发生率比较差异均有统计学意义(P<0.05)。两组关节功能优良率比较差异无统计学意义(P>0.05)。结论克氏针钢丝张力带固定术后并发症发生率较高,但关节功能优良率与髌骨针钛缆张力带固定比较无明显差异,且具有缩短住院时间、降低住院费用等优点。     

改良张力带内固定治疗髌骨骨折

我科从2001年10月-2005年1月,采用单枚克氏针弯成“V”形张力带内固定治疗髌骨骨折322例,取得了满意疗效,报告如下。1临床资料本组322例,男184例,女138例;年龄18~76岁,平均48·4岁。闭合伤241例,开放伤81例。所有病例均为新鲜骨折。受伤原因:跌伤223例,车祸78例,高空坠落伤21例     

张力带及髌骨环治疗髌骨骨折的疗效成本分析

[目的]比较张力带及髌骨环治疗髌骨骨折的临床疗效及医疗费用,为选择经济有效的手术方式提供依据。[方法]回顾分析2015年1月～2016年8月石河子大学医学院第一附属医院骨科中心收治的99例髌骨骨折患者,根据不同术式分为张力带组(53例)和髌骨环组(46例),记录两组患者的骨折愈合时间、术后并发症、Bostman评分、膝关节疼痛VAS评分和医疗费用,计算成本效果比、增量效果比。[结果]张力带组术后并发症发生率高于髌骨环组(P0.05),术后1年张力带组的Bostman评分差于髌骨环组(P0.05);术后2年两组间的Bostman评分、VAS评分差异无统计学意义(P0.05)。张力带组首次住院费、医疗总费用显著低于髌骨环组(P0.05),而张力带组在并发症治疗费用上高于髌骨环组(P0.05)。成本效果比显示Bostman评分每提高1分两组患者分别需支付431.93元和631.04元;张力带组中取出内固定患者术后2年的Bostman评分显著高于未取内固定患者(P0.05),取出内固定患者与未取出内固定患者Bostman评分每提高1分需分别支付497.66和355.69元。[结论]张力带及髌骨环治疗髌骨骨折均能获得较为满意的远期疗效,但张力带可能是一种更为经济有效的手术方式。     

克氏针张力带治疗髌骨骨折

2001年3月～2010年12月,我科采用克氏针张力带治疗髌骨骨折45例,均取得满意效果。1材料与方法1.1病例资料本组45例,男33例,女12例,年龄24～73岁。横断形骨折35例,粉碎性骨折10例;新鲜闭合骨折39例、陈旧性骨折2例,开放骨折4例。1.2手术方法腰麻或连硬外麻醉。髌前纵形切口,长45～55 cm,复位较大     

W形克氏针结合张力带钢丝内固定治疗髌骨骨折

目的探讨W形克氏针结合张力带钢丝内固定治疗髌骨骨折的临床疗效。方法对38例髌骨骨折患者采用髌前纵行切口,骨折复位后均行W形克氏针结合张力带钢丝内固定。结果 38例均获随访,时间8-24个月。骨折均达骨性愈合,髌骨关节面光整,无克氏针旋转、内固定物松动、断裂等并发症发生。关节功能根据Lysholm膝关节评分标准：优36例,良2例。结论 W形克氏针结合张力带钢丝内固定治疗髌骨骨折预防了改良张力带由于克氏针的旋转刺破皮肤而影响功能恢复等并发症发生。该方法操作方便,创伤小,固定牢靠,能早期活动,符合生物力学原理,临床疗效满意。     

可吸收钉棒系统加可吸收锚钉内固定治疗髌骨骨折

2007年9月～2009年8月,我科采用可吸收钉棒系统加可吸收锚钉治疗髌骨骨折16例,效果满意,报道如下。1材料与方法1.1病例资料本组16例,男9例,女7例,年龄18～50岁。左侧10例,右侧6例。均为新鲜骨折,横形骨折12例,     

Comparison of double-strand braided polyester sutures tension band (Nice knot) with cable tension band in transverse patellar fractures

BackgroundThe tension band technique is the most common method for internal fixation of transverse patellar fractures. Titanium cable and high-strength sutures have been successfully applied in this treatment; however, few studies have compared the Nice knot technique using sutures with the standard cable technique. Whether the suture technique (Nice knot) provides preferable results compared with those of the cable technique is unclear.MethodsForty patients with transverse patellar fractures participated in this study. Twenty patients underwent sutures tension band fixation (Nice knot), and the others were managed with cable tension bands. All patients were followed up at 1, 3, 6, and 12 months. Pain was measured by VAS scores, flexion and extension of the knee were measured in degrees by goniometry, and knee function was evaluated using the Böstman clinical grading scale.ResultsThe two groups had equal distributions in age, gender, injured side, and fracture classification. The mean operation time in the suture group was shorter (55.75±9.77 minutes versus 64.25±9.63 minutes). The VAS score was comparable in the two groups at the 1-month, 3-month, and 6-month follow-ups; however, the score was lower at 12 months postoperatively in the suture group (P=0.037). No significant difference was found in flexion, extension, Böstman score, or fracture healing time in either group (P>0.05). Postoperative complications were higher in the cable group (9 versus 2) (P = 0.031) but were mostly related to symptomatic soft tissue irritation.ConclusionThe suture tension band technique using braided polyester nonabsorbable sutures tied with Nice knot was as effective as the cable tension band technique for transverse patellar fracture management. However, more convenient operations, less cost and fewer complications were found in suture fixation (Nice knot).     

可吸收固定棒结合环扎加钢丝内固定治疗髌骨粉碎性骨折

2007年9月-2010年8月,我们采用聚左旋乳酸可吸收固定棒结合抗米微侨可吸收线环扎加＂8＂字钢丝内固定治疗43例髌骨粉碎性骨折,疗效满意。