双缝线锚钉交替环抱固定髌骨下极骨折

Intersected cerclage fixation of patellar lower pole fractures with double suture anchors

摘要:

[目的]介绍双锚钉交替环抱固定髌骨下极骨折的手术技术及初步效果。[方法]对 26 例髌骨下极骨折患者使用双锚钉交替环抱法治疗。髌前正中切口，显露骨折端，双锚钉分别置于骨折近端完整骨质的两侧，篮网状交替缝合髌骨下极并进行打结，于髌骨近端 1/3 处做 2 mm 骨道，两侧剩余锚钉线沿髌骨支持带腱骨结合的扩张部向近端缝合，在近端骨道处经骨道交叉至对面，双股线于髌骨表面向远端做 8 字交叉，然后在髌腱远端行 Krachow 缝合法。[结果] 所有患者均顺利手术，无严重术中并发症。术后随访 12 个月以上。随时间推移，患者行走功能逐渐改善，末次随访时 VAS 评分 0.1 分，Bostman 评分为 29.7，膝关节活动度为 132.8°。影像方面，所有患者在术后 4~6 周骨折端出现骨痂，10~12 周明确骨性愈合。术后 1 年所有患者屈膝 30°侧位的 Insall–Salvati ratio 为（1.2±0.1）。所有患者均无锚钉脱落及骨折再移位等不良影像征象。[结论]双锚钉交替环抱固定髌骨下极骨折手术操作可行，固定可靠，利于早期恢复，初步临床效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary results of cerclage fixation of inferior pole fractures of the patella with double suture anchors. [Methods] A total of 26 patients received open reduction and internal fixation with intersected cerclag- es of double anchors for inferior pole fractures of the patella. After double suture anchors were placed on both sides of the intact bone of the proximal end, the inferior pole of the patella was sutured and knotted in a mesh alternatingly. A transvers bone hole 2 mm in diameter was made at the upper 1/3 of the proximal end, and then the sutures were stitched with the patellar retinaculum on both side up to the level of the hole, and passed the hole to the opposite side respectively. The sutures were crossed in 8-figure over the anterior surface of the patella, and stitched with the distal patellar tendon in Krachow manner. [Results] All patients were successfully operated on without serious intraop- erative complications, and followed up for more than 12 months. All the patients got walking function gradually improved over time, with VAS score of 0.1, Bostman score of 29.7 and knee range of motion of 132.8° at the latest follow-up. Radiographically, callus appeared on the fracture ends in all patients 4~6 weeks, and bony union was clear 10~12 weeks after surgery. The Insall-Salvati ratio was of (1.2±0.1) at 30° knee flexion on lateral review 1 year after surgery. All patients had no adverse imaging signs such as anchor loosening and fracture redisplacement. [Conclusion] The intersected cerclages of double anchors for fixation of inferior pole fractures of the patella are feasible and reliable, with satisfactory preliminary clinical outcome.