带线锚钉“8”字缝合固定髌骨下极骨折△

Anchor suture with figure of 8 stitch for fixation of patellar lower pole fractures

摘要:

[目的]介绍带线锚钉“8”字缝合固定髌骨下极骨折的手术技术和初步临床应用效果。[方法]2017 年 6 月—2019 年 12 月采用上述技术固定髌骨下极骨折 38 例。行膝前正中切口，暴露骨折端。于近髌骨置入 1 枚 5.0 mm 带线锚钉。锚钉旁使用 2-0 克氏针自髌骨前方分别斜向两侧钻孔至髌骨后方关节面，出针点在骨折断端上方约 0.1 mm，使用硬膜外导针将锚钉上两股缝线的单边分别自上述钻孔中引出，锚钉线分别从髌骨下极两侧缝合编织在髌韧带上，自行打结收紧。然后将两股缝线上的另一单边自髌骨一侧锚钉处为起点，连续缝合至同侧髌韧带近端，绕髌韧带缝合至对侧，再缝合至起点处自行收紧打结。 [结果]38 例患者均顺利完成手术。骨折愈合时间 14~16 周，无内固定失效病例，膝关节稳定性良好。术后 12 个月 Bostman 髌骨骨折评级标准，优 30 例，良 7 例，优良率 97.37%。[结论] 带线锚钉治疗髌骨下极骨折，修复了伸膝装置，操作简单安全，术后膝关节功能恢复优良，且无需二次手术取出，疗效满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of anchor suture with figure of 8 stitch for fixation of patellar lower pole fractures. [Methods] From June 2017 to December 2019, 38 patients had patella lower pole fractures fixed with the above techniques. An anterior midline incision was made on the knee to expose the fracture ends. A 5.0 mm wire anchor was placed on the proximal fracture end of the patella. Two bone tunnels were created by using Kirschner wire 2-0 in diameter from the front on both sides to patellar articular surface posteriorly emerging 0.1 mm above the fracture end. The sutures were introduced through the tunnels by using epidural needle and stitched with the distal patellar end and tendon in woven, tightened and knotted. Then, two sutures were con- tinuously sutured back to the starting point on the proximal patellar end, and was tightened and tied. [Results] All 38 patients had operation completed successfully. At 12 months after the operation, the clinical outcomes were graded as excellent in 30 cases and good in 7 cases based on Bostman's criteria for patella fracture, with excellent and good rate of 100%. The knee joint stability was good. [Conclusion] This suture anchor technique for treatment of patellar lower pole fractures is simple and safe in surgical operation, get well knee functional recov- ery without the need of second operation to remove the implant.