经皮微创治疗粉碎性髌骨骨折1.docx

经皮微创治疗粉碎性髌骨骨折 周凯华，杨军，潘福根 摘要 目的：探讨经皮微创治疗粉碎性髌骨骨折的临床疗效和适应症。 方法：自2008年2月至2013年6月，共有28例粉碎性髌骨骨折患者入选采取经皮微创内固定。术后对所有患者的骨折愈合时间，VAS评分，关节活动度以及Bostman评分进行评估分析。 结果：所有患者术后均接受随访。平均随访时间为34.4个月（13～53个月），平均手术时间为72.3±31.9分钟，平均术中透视次数为7.6±2.4次，骨折愈合时间为13.7±2.6周。术后1月及骨折愈合时的VSA评分分别为3.4±1.0和1.2±1.0。所有患者在最后一次随访时膝关节活动度为139.8±5.4°。术后1年Bostman评分为28.8±1.0，其中评分达到优的患者为26例。所有随访患者中发现1例钢丝断裂，但此时骨折已愈合。随访中未见克氏针断裂、骨折移位、伤口感染、骨不连等并发症。 结论：经皮微创治疗粉碎性髌骨骨折手术创伤小，内固定稳定可靠，可早期功能锻炼，有利于骨折早期愈合，患者术后功能恢复良好。 关键词：微创，粉碎性，髌骨骨折 Surgical treatment of HYPERLINK javascript:void(0); comminuted patella fractures with a percutaneous minimally invasive technique Kai-hua Zhou, Jun Yang, Fu-gen Pan Abstract Objection: To evaluate outcome and operation indication of percutaneous minimally invasive surgery for comminuted patella fractures Methods: From February 2008 to June 2013, 28 patients with comminuted patella fractures were included in this study. Radiographs, pain, operation time, range of motion, functional score and complications were evaluated postoperatively. Results: All patients received follow-up. The mean follow-up period was 34.4months（13～53months）. The mean operation time was 72.3±31.9minutes. Intraoperative fluoroscopy was 7.6±2.4 times. Radiographic evidence of solid fracture union was observed in all cases in a mean period of 13.7±2.6weeks. The Visual Analog Scale score for pain was 3.4±1.0 at 4 weeks after surgery and 1.2±1.0 when radiographic fracture healing was achieved. At the latest follow-up, the range of motion was all 139.8±5.4°. The mean Bostman Score was 28.8±1.0 at 1 year after surgery, and an evaluation of “excellent” was observed in 26 patients at the final follow-up. We only found one case with steel wire broken, but the fracture had already been union. There were no other complications such as K-wire broken, fracture displacement, wound infection and bone nonunion. Conclusion: Surgical treatment of comminuted patella fractures by percutaneous minimally invasive technique provided satisfactory cli