经皮微创治疗粉碎性髌骨骨折1

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1、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

2、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Surgicaltreatmentofcomminutedpatellafractureswithapercutaneousminimallyinvas

3、ivetechniqueKai-huaZhou,JunYang,Fu-genPanAbstractObjection:ToevaluateoutcomeandoperationindicationofpercutaneousminimallyinvasivesurgeryforcomminutedpatellafracturesMethods:FromFebruary2008toJune2013,28patientswithcomminutedpatellafractureswereincludedinthisstudy.Radiogr

4、aphs,pain,operationtime,rangeofmotion,functionalscoreandcomplicationswereevaluatedpostoperatively.Results:Allpatientsreceivedfollow-up.Themeanfollow-upperiodwas34.4months（13～53months）.Themeanoperationtimewas72.3±31.9minutes.Intraoperativefluoroscopywas7.6±2.4times.Radiog

5、raphicevidenceofsolidfractureunionwasobservedinallcasesinameanperiodof13.7±2.6weeks.TheVisualAnalogScalescoreforpainwas3.4±1.0at4weeksaftersurgeryand1.2±1.0whenradiographicfracturehealingwasachieved.Atthelatestfollow-up,therangeofmotionwasall139.8±5.4°.ThemeanBostmanScor

6、ewas28.8±1.0at1yearaftersurgery,andanevaluationof“excellent”wasobservedin26patientsatthefinalfollow-up.Weonlyfoundonecasewithsteelwirebroken,butthefracturehadalreadybeenunion.TherewerenoothercomplicationssuchasK-wirebroken,fracturedisplacement,woundinfectionandbonenonuni

7、on.Conclusion:Surgicaltreatmentofcomminutedpatellafracturesbypercutaneousminimallyinvasivetechniqueprovidedsatisfactoryclinicalresultsandexcellentkneefunction.Ithasadvantagesofsmallincisionandfixationstability,earlyfracturehealing.Thepatientscancarryearlyrehabilitationex

8、ercise.Butweshouldknowwellaboutthesurgicalindicationofthistechniqueandoperationskills.Keywords:minimall