【摘要】 目的 了解髌骨骨折前正中入路的临床应用。方法 通过21例髌骨骨折采用前正中入路手术,比较手术操作,术后锻炼,功能恢复等,初步评价其优缺点。结果 前正中入路视野暴露好,操作方便,手术时间缩短。21例患者术后第3天即可行膝关节锻炼,无刀口裂开,瘢痕小,无伸屈功能受限,恢复满意,优良率为95.2%。结论 前正中入路损伤小,固定满意,早期锻炼安全,功能恢复快,是一个比较理想的入路,值得推荐。
【关键词】 切口;髌骨骨折
Clinical application of anterior median incision in patella fracture
LIU Xin, WANG Siqun, LI Weiguo
(Department of Orthopaedics, Luohu People s Hospital, Shenzhen 518001, China)
Abstract: Objective To investigate the clinical significance of the anterior median incision in the treatment of patella fracture. Methods Twentyone patients with patella fracture underwent the anterior median approach to the knee. The advantages of the operation were evaluated by operative procedure, postoperative training, functional recovery and so on. Results Good operative field, convenient management and short operation time were the main merits during the operative procedure. Postoperative training of knee joint started on the 3rd postoperative day in all patients. There was no wound disruption. The fine rate of treatment was 95.2%. Conclusion The main advantages of this approach include less damage, satisfactory fixation, safety of early training, and fast functional recovery, which deserves to be introduced in clinical application.
Key words:incision; patella fracture
髌骨骨折的传统标准手术切口为髌前横弧形切口[1],曾认为前正中切口影响关节功能,故大多数手术学无相关介绍,但近些年前正中直切口的独特优势被逐步认识,我院于2006年3月至2007年8月采用髌前正中入路治疗髌骨骨折21例,现将结果报道如下。
1 临床资料
1.1 一般资料
本组21例均为新鲜骨折,其中男16例,女5例,年龄22~56岁,平均44岁。21例中属左侧髌骨骨折12例,右侧9例;骨折类型:横断骨折5例,粉碎性骨折16例。
1.2 手术方法
连续硬膜外麻醉后,患者取仰卧位,常规消毒铺巾,切口(如图1)起自髌骨上极1.5 cm处纵行达髌骨下极1.5 cm,切开皮肤及皮下组织至髌前腱膜,向两侧游离皮瓣显示支持带扩张部,如支持带已断裂,则从其破口处探查骨折复位后关节面平整程度,如支持带完整,则分别于髌旁内、外侧做1.5 cm长的纵行探查切口。清理骨折端,保护髌周软组织与骨折碎片的联系,这既有利于骨折复位,也有助于骨折血供。用0.9%氯化钠溶液冲洗关节腔,以大巾钳夹持髌骨两极向中心靠拢,通过探查口用手指触及关节面,了解其平整程度满意后,可据情选用张力带钢丝固定、镍钛形态记忆聚髌器固定、钢丝环扎固定等。被动活动膝关节,检查内固定牢固程度及关节面平整程度,确定解剖复位,再次以0.9%氯化钠溶液冲洗关节腔,7号线修补支持带破损处,逐层关闭伤口后加压包扎。术后第3
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