[1]陈星宇,刘显东,曹万军,等.髌骨骨折克氏针张力带钢丝内固定术后克氏针松动的原因分析及应对策略[J].中医正骨,2017,29(01):23-26.
　CHEN Xingyu,LIU Xiandong,CAO Wanjun,et al.K-wire loosening after internal fixation with tension band made of K-wire and steel-wire for treatment of patella fractures:cause analysis and coping strategies[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(01):23-26.
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髌骨骨折克氏针张力带钢丝内固定术后克氏针松动的原因分析及应对策略()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年01期
页码:
23-26
栏目:
临床研究
出版日期:
2017-01-20

文章信息/Info

Title:
K-wire loosening after internal fixation with tension band made of K-wire and steel-wire for treatment of patella fractures:cause analysis and coping strategies
作者:
陈星宇1; 刘显东1; 曹万军1; 杜亮2; 唐承杰1; 郑金文1
1.四川省骨科医院,四川 成都 610041;
2.四川省广安市广安区人民医院,四川 广安 638550
Author(s):
CHEN Xingyu1; LIU Xiandong1; CAO Wanjun1; DU Liang2; TANG Chengjie1; ZHENG Jinwen1
1.Sichuan Orthopaedic Hospital,Chengdu 610041,Sichuan,China 2.The People's Hospital of Guang'an district in Guang'an City,Guang'an 638550,Sichuan,China
关键词:
髌骨;  骨折;  骨折固定术; 内;  手术后并发症;  相关分析;  克氏针松动
Keywords:
patella;  fractures; bone;  fracture fixation; internal;  postoperative complications;  correlation analysis;  Kirschner wire loosening
摘要:
目的:分析髌骨骨折克氏针张力带钢丝内固定术后导致克氏针松动的可能原因,并探讨其应对策略。方法:收集2014年1月至2015年12月采用克氏针张力带钢丝内固定术治疗后出现克氏针松动的17例髌骨骨折患者的X线片,应用infiniti系统软件测量克氏针退针距离、针尾部的弯曲度数、针尖至髌骨下极的距离以及克氏针与股四头肌轴线的夹角,并采用Pearson相关分析法分析退针距离与其他3项参数的关系。结果:克氏针退针距离[(10.02±5.56)mm]与克氏针尾部的弯曲度数(117.30°±3.52°)、克氏针和股四头肌轴线的夹角(17.35°±1.75°)均呈负相关(r=-0.774,P=0.013; r=-0.710,P=0.007),与克氏针针尖至髌骨下极的距离[(11.17±0.81)mm]呈正相关(r=0.550,P=0.037)。结论:导致髌骨骨折克氏针张力带钢丝内固定术后克氏针松动的可能原因包括克氏针尾部弯曲度数小、克氏针和股四头肌轴线的夹角小、克氏针针尖至髌骨下极的距离大。术中应适当增加克氏针尾部的弯曲度数及克氏针与股四头肌轴线的夹角,适当控制克氏针针尖至髌骨的距离,以降低克氏针松动的可能性。
Abstract:
Objective:To study the possible causes and coping strategies of K-wire loosening after internal fixation with tension band made of K-wire and steel-wire for treatment of patella fractures.Methods:The X-ray films of 17 patients with patella fractures who developed K-wire loosening after internal fixation with tension band made of K-wire and steel-wire from January 2014 to December 2015 were collected.The needle withdrawal distance,bending-degree of needle tail,distance from needle tip to patellar distal extreme and included angle between K-wire and axis of quadriceps femoris were measured by using infiniti system software,and the relationships between needle withdrawal distance and other 3 parameters were analyzed by using Pearson correlation analysis.Results:The needle withdrawal distance(10.02+/-5.56 mm)was negatively correlated(r=-0.774,P=0.013; r=-0.710,P=0.007)with the bending-degree of needle tail(117.30+/-3.52 degrees)and the included angle between K-wire and axis of quadriceps femoris(17.35+/-1.75 degrees),and was positively correlated(r=0.550,P=0.037)with the distance from needle tip to patellar distal extreme(11.17+/-0.81 mm).Conclusion:The possible causes of K-wire loosening after internal fixation with tension band made of K-wire and steel-wire for treatment of patella fractures include small bending-degree of needle tail,small included angle between K-wire and axis of quadriceps femoris and long distance from needle tip to patellar distal extreme,so the bending-degree of needle tail and the included angle between K-wire and axis of quadriceps femoris should be properly increased and the distance from needle tip to patellar distal extreme should be properly controlled in the surgery so as to reduce the possibility of K-wire loosening.

参考文献/References:

[1] 徐洪璋,余斌.髌骨骨折AO张力带内固定有限元模型的建立和分析[J].中国组织工程研究与临床康复,2011,15(13):2339-2344.
[2] RUEDI TP,MURPHY WM.骨折治疗的AO原则[M].王满宜,杨庆铭,曾炳芳,等译.北京:华夏出版社,2003:483-484.
[3] 董正超,姚新苗.髌骨骨折的分型及内固定治疗进展[J].中医正骨,2015,27(8):58-60.
[4] THELEN S,BETSCH M,SCHNEPPENDAHL J,et al.Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate[J].Orthopedics,2013,36(11):1437-1443.
[5] DICKENS AJ,SALAS C,RISE LR,et al.Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation:a biomechanical study[J].Injury-international Journal of the Care of the Injured,2015,46(6):1001-1006.
[6] 李健,颜登鲁,高梁斌,等.微创张力带固定治疗横断型髌骨骨折的基础与临床研究[J].中国临床解剖学杂志,2004,22(6):668-371.
[7] 樊正军,于广海,蔡玉田,等.三种方法治疗髌骨骨折的比较[J].中国矫形外科杂志,2014,22(16):1509-1512.
[8] 郭楠.不同类型髌骨骨折手术治疗与并发症分析[J].医疗装备,2016,29(2):100-101.
[9] SCHUETT DJ,HAKE ME,MAUFFREY C,et al.Current treatment strategies for patella fractures[J].Orthopedics,2015,38(6):377-384.
[10] MATSUO T,WATARI T,NAITO K,et al.Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures[J].Strategies in trauma and Limb Reconstruction,2014,9(1):l9-23.
[11] 喻单根,李宏杰,张建河,等.两种不同方法固定治疗髌骨骨折的疗效分析[J].实用骨科杂志,2016, 22(2):169-171.
[12] THELEN S,SCHNEPPENDAHL J,BAUMGÄRTNER R,et al.Cyclic long-term loading of a bilateral fixed-angle plate in comparison with tension band wiring with K-wires or cannulated screws in transverse patella fractures[J].Knee Surg Sports Traumatol Arthrosc,2013,21(2):311-317.
[13] MÜLLER ME,ALLGÖWER M,SCHNEIDER R,et al.骨科内固定[M].3版.荣国威,翟桂华,刘沂,等主译.北京:人民卫生出版社,1995:393.
[14] 葛孚章,郑进友.两种方法治疗髌骨骨折的疗效比较[J].中国矫形外科杂志,2013,21(12):1249-1251.
[15] 靳安民,汪华桥.骨科临床解剖学[M].济南:山东科学技术出版社,2010:323-324.

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备注/Memo

备注/Memo:

通讯作者:刘显东 E-mail:liuxiandong@163.com
更新日期/Last Update: 2017-01-20