本文選題：微型鋼板　切入點(diǎn)：鋼絲張力帶　出處：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:近年來隨著交通業(yè)、建筑業(yè)的進(jìn)步,髕骨骨折發(fā)生率尤其是粉碎性骨折的發(fā)生率呈上升趨勢,人們對髕骨骨折治療經(jīng)歷了一個漫長的歷史,在1877年之前,多采用保守治療,即采用膝關(guān)節(jié)支架,臥床休息,使骨折達(dá)到二期愈合,即通過骨痂形成方式,造成嚴(yán)重的膝關(guān)節(jié)功能障礙。1877年,Cameron第一次在國際上打破常規(guī)地提出髕骨骨折切開復(fù)位的發(fā)法。隨后的100多年里,各種內(nèi)固定材料出現(xiàn)在髕骨治療之中。最經(jīng)典的內(nèi)固定是克氏針張力帶固定,但是對于一些粉碎性的骨折,AO張力帶固定常出現(xiàn)較高失敗率和并發(fā)癥,人們開始了對髕骨骨折手術(shù)各種類型內(nèi)固定物的探索與研究。本課題探討微型鋼板內(nèi)固定治療髕骨骨折的臨床療效和可行性,為臨床治療髕骨骨折手術(shù)方式的提供新的內(nèi)固定方法。方法:回顧性分析我科2012年9月-2014年9月接受手術(shù)治療的23例髕骨骨折患者的臨床資料,患者術(shù)前CT,均為閉合性新鮮骨折,受傷時間至手術(shù)時間為2小時-3天,平均1.2天,所有病例按髕骨Saunders分型分類:非粉碎骨折(橫行骨折)8例,粉碎型骨折15折例。分為實(shí)驗(yàn)組和對照組,二者均采用髕前正中縱行切口。實(shí)驗(yàn)組:患者均采用微型鋼板固定髕骨12例,其中,非粉碎骨折(橫行骨折)4例,粉碎型(3塊及以上)骨折8例;對照組:患者均采用克氏針張力固定11例,其中,非粉碎骨折4例,粉碎骨折(3塊及以上)7例。手術(shù)方法:①微型鋼板組:采用椎管內(nèi)麻醉后,判斷患者麻醉效果滿意,術(shù)者用碘酒、酒精消毒,鋪無菌巾、單,屈曲患膝,止血帶充氣至300mm Hg,取髕骨前正中縱行切口,逐層切開皮膚、皮下組織,切開髕骨前深筋膜再兩側(cè)分離,顯露髕前腱膜及骨折斷端,清理凝血塊及微小骨折塊,點(diǎn)狀復(fù)位鉗結(jié)合克氏針復(fù)位骨折斷端,C型臂機(jī)下透視關(guān)節(jié)面和骨折復(fù)位均滿意后將鋼板覆蓋骨面之上,再相應(yīng)孔內(nèi)鉆孔、測深、在相應(yīng)螺孔內(nèi)擰入螺釘。必要時穿克氏針加強(qiáng)固定強(qiáng)度,確保主要骨折塊均被微型鋼板和螺釘覆蓋并堅(jiān)強(qiáng)固定,再次C型臂透視,微型鋼板、螺釘和髕骨關(guān)節(jié)面位置均滿意,術(shù)中被動活動膝關(guān)節(jié),無異常后松止血帶,徹底止血后逐層縫合傷口。②克氏針張力帶組(由直徑2.0mm克氏針和0.8mm鋼絲組成):患肢采用椎管內(nèi)麻醉,術(shù)者用碘酒、酒精消毒,鋪無菌巾、單,屈曲患肢,止血帶充氣至300mm Hg,取髕骨前正中縱行切口,逐層切開皮膚、皮下組織,切開髕骨前深筋膜再兩側(cè)分離,顯露髕前腱膜及骨折斷端,點(diǎn)狀復(fù)位鉗結(jié)合克氏針復(fù)位骨折斷端,尖嘴復(fù)位鉗復(fù)位骨折斷端,分別以2.0mm克氏針固將小的骨折塊固定到主要骨折塊上,再利用將鋼絲繞克氏針頭、尾部建立張力帶,與在髕骨下極鋼絲交叉打結(jié),鋼絲擰鎖緊,剪去多余的鋼絲,殘端光滑處理,將克氏針尾端彎曲,凸向外,盡可能術(shù)中減少對局部軟組織尤其是前側(cè)軟組織的刺激。同樣的方法將不同的小骨塊固定到主要骨塊上。如為粉碎骨折,利用多個張力帶,反復(fù)將鋼絲纏繞克氏針。術(shù)后被動活動關(guān)節(jié),無異常后松止血帶,徹底止血后逐層縫合傷口。術(shù)后處理:所有患者都接受相同的用藥、功能指導(dǎo)和康復(fù)鍛煉。統(tǒng)計(jì)學(xué)分析:所有患者數(shù)據(jù)均被觀察并記錄,包括患者手術(shù)切口的愈合時間、骨折愈合時間、骨折愈合后膝關(guān)節(jié)功能。應(yīng)用統(tǒng)計(jì)軟件SPSS16.0進(jìn)行統(tǒng)計(jì)學(xué)分析,采用樣本t檢驗(yàn)評價兩組患者的手術(shù)切口愈合時間,采用樣本卡方檢驗(yàn)兩種內(nèi)固定術(shù)后3個月髕骨的骨折愈合率,采用樣本秩和檢驗(yàn)檢驗(yàn)膝關(guān)節(jié)功能優(yōu)良率,選取P0.05作為有統(tǒng)計(jì)學(xué)差異的標(biāo)準(zhǔn)。結(jié)果:1 23位患者均獲隨訪,所有隨訪時間7-16個月,平均時間為12個月,所有的手術(shù)切口經(jīng)觀察并統(tǒng)計(jì)均甲級愈合。兩種手術(shù)方式的術(shù)中手術(shù)切口愈合時間被比較后,兩者無統(tǒng)計(jì)學(xué)意義(P0.05)。(Table 1)2對兩種手術(shù)方式的骨折愈合進(jìn)行比較,兩者無統(tǒng)計(jì)學(xué)意義(P0.05)。(Table 1)3骨折愈合后,采用Bostman膝關(guān)節(jié)功能評分,微型鋼板組患者骨折愈合后總體膝關(guān)節(jié)功能優(yōu)良率高于克氏針張力帶組總體優(yōu)良率(P0.05)。橫行骨折組膝關(guān)節(jié)功能優(yōu)良率和克氏針張力帶組總體優(yōu)良率無統(tǒng)計(jì)學(xué)差異(P0.05)。粉碎骨折組膝關(guān)節(jié)功能優(yōu)良率和克氏針張力帶組總體優(yōu)良率有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1兩種手術(shù)方式都能較好復(fù)位固定簡單橫行髕骨骨折,骨折愈合率相當(dāng);2微型鋼板大小、尺寸等不會妨礙傷口愈合;3微型鋼板在固定粉碎性髕骨骨折方面較多枚克氏針鋼絲張力帶固定具有優(yōu)勢,術(shù)后復(fù)查有較好的膝關(guān)節(jié)功能。
[Abstract]:Objective: in recent years, along with the transportation industry, construction progress, especially the incidence of fracture of patella comminuted fracture incidence is rising, people in treatment of patellar fracture has a long history, before 1877, the use of conservative treatment, with a knee brace, bed rest, the fracture reached two healing by callus formation, causing serious knee joint dysfunction in.1877, Cameron for the first time in the world to put forward the break the normal procedure of open reduction method of patella fracture. For the next 100 years, a variety of internal fixation materials in treatment of patella. The classic internal fixation of Kirschner wire tension belt however, for some comminuted fracture fixation, often high failure rate and complications of AO tension band, people began to explore the operation of various types of internal fixation of fracture of patella and Research on this topic. The clinical efficacy and feasibility of mini plate internal fixation for treatment of patellar fractures, internal fixation methods provide new surgical methods for the clinical treatment of patellar fractures. Methods: a retrospective analysis in September 2012 September -2014 accepted surgical treatment of 23 cases of patients with patella fracture clinical data, preoperative CT, were closed fresh fractures the time of injury to the operation time is 2 hours -3 days, average 1.2 days, according to the classification of all cases of patellar Saunders: non comminuted fracture (transverse fracture) in 8 cases, 85% off cases of comminuted fractures. Divided into experimental group and control group, two patients with patellar anterior median longitudinal incision. Experimental group: patients were treated by mini plate fixation of patella in 12 cases, among them, the non comminuted fracture (transverse fracture) in 4 cases, crush type (3 and above) fracture in 8 cases; control group: patients were treated with Kirschner wire fixation in 11 cases, among them, 4 cases of non comminuted fracture, comminuted fracture (3 blocks and to On 7 cases of surgery). Methods: the mini plate group: after spinal anesthesia, patients satisfactory anesthesia, patients with iodine, alcohol disinfection, sterile towel, single, knee flexion, tourniquet to 300mm Hg, patella anterior median incision, incision of skin and subcutaneous tissue layer open, deep fascia and patella before separation on both sides, reveal the prepatellar aponeurosis and fracture, clean blood clot and micro fracture, point reduction forceps combined with Kirschner wire reduction and fracture under the C-arm fluoroscopy C articular surface and fracture reduction were satisfied after the cover plate on the bone surface, and the corresponding hole in drilling, sounding, in the corresponding holes in the screw. When necessary, wear Kirschner wire fixation strength to strengthen, to ensure that the main fracture fragments were micro plates and screws covered and strong fixation, again C arm fluoroscopy, mini plate and screw, and the articular surface of the patella position were satisfactory, passive activities in operation Knee joint, no abnormal after tourniquet release, thorough hemostasis after sutured wounds. The Kirschner wire tension band group (consisting of 2.0mm diameter Kirschner wire and 0.8mm): limb by spinal anesthesia, patients with iodine, alcohol disinfection, sterile towel, single limb, buckling, hemostatic belt inflatable to 300mm Hg, patella anterior median longitudinal incision, cut the skin, subcutaneous tissue layer, deep fascia and patellar incision before separation on both sides, revealing the prepatellar aponeurosis and fracture point reduction forceps combined with Kirschner wire reduction and fracture reduction forceps beak fracture, Kirschner wires respectively by 2.0mm the small solid fracture block fixed to the main fracture block, then use the wire around the Kirschner needle, a tail tension band in the lower pole of the patella and wire cross tie wire, screw locking, cut off the excess wire, stump smooth processing, Kirschner wire end bending, convex outward, as far as possible surgery may reduce Few of the local soft tissue especially the anterior soft tissue stimulation. The same method will be different bone block fixed to the main bone. As for comminuted fracture, using multiple tension band Kirschner wire winding will be repeated. After passive joint, no abnormal after tourniquet release, complete bleeding gradually after suture wound. Postoperative postprocessing: all patients received the same medication, the function of guidance and rehabilitation exercise. Statistical analysis: all the patients were observed and recorded data, including incision healing time, fracture healing time, the function of knee joint after fracture healing. The application of statistical software SPSS16.0 statistical analysis, healing time of surgery incision of the sample t test was evaluated in two groups, using the chi square test sample of two kinds of internal fixation after 3 months of patella fracture healing rate, the excellent rate of sample rank and inspection of knee joint function, select P0 There were significant differences in.05 as the standard. Results: 123 patients were followed up, all patients were followed up for 7-16 months, the average time was 12 months, all the incision healed after observation and statistics were compared. A healing time of incision surgical operation in two, the two was not statistically significant (P0.05 (Table). 1) 2 of the two surgical methods of fracture healing were compared, there was no statistical significance (P0.05). (Table 1) 3 after fracture healing, the Bostman knee function score, the excellent rate of patients with fracture of mini plate group total knee joint function after healing compared with Kirschner wire tension band group overall the excellent rate (P0.05). With the excellent and good rate of knee joint function group and Kirschner wire tension band group overall excellent rate showed no significant difference (P0.05). The fracture crushing group excellent rate of knee joint function and Kirschner wire tension band group overall rate had statistical difference between fracture (P0.05) Conclusion: 1. Two kinds of surgical methods can better fixation and simple transverse patellar fracture, fracture healing rate is 2; mini plate size, size does not interfere with wound healing; 3 mini plate in treatment of comminuted patella fracture with more Kirschner wire tension band fixation has advantages, postoperative knee joint good function.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【共引文獻(xiàn)】

相關(guān)期刊論文 前2條

1 李孔健;黃芳;盧雪云;;關(guān)節(jié)鏡輔助下髕骨骨折復(fù)位經(jīng)皮空心螺釘張力帶內(nèi)固定56例臨床分析[J];嶺南急診醫(yī)學(xué)雜志;2015年01期

2 方志;張建軍;劉躍洪;劉樹平;;關(guān)節(jié)鏡微創(chuàng)術(shù)在髕骨骨折手術(shù)中的應(yīng)用研究[J];中國實(shí)用醫(yī)藥;2013年28期

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本文編號：1654653