Rockwood Ⅲ型髕骨骨折采取帶線錨釘Krackow縫合法的臨床研究

【摘要】 目的：探究Rockwood Ⅲ型髕骨骨折采取帶線錨釘Krackow縫合法治療的臨床效果。方法：選取江西嘉佑曙光骨科醫院2020年1月—2022年4月骨科收治的60例Rockwood Ⅲ型髕骨骨折患者為研究對象，采用隨機數字表法分為觀察組（n=30）與對照組（n=30）。對照組采用髕骨爪內固定術治療，觀察組采用帶線錨釘Krackow縫合法治療。比較兩組術前與術后2、4、8個月傷側Bostman髕骨骨折功能評分、術前及術后1周、2周、1個月視覺模擬評分法（visual analogue scale，VAS）評分，比較兩組術前與術后5 d白介素-6（IL-6）、白介素-10（IL-10）及腫瘤壞死因子-α（TNF-α）水平，比較兩組手術情況、臨床療效和并發癥。結果：觀察組術后2、4個月Bostman髕骨骨折功能評分均高于對照組，術后1、2周VAS評分均低于對照組（Plt;0.05）；兩組術前IL-6、IL-10和TNF-α水平比較，差異均無統計學意義（Pgt;0.05）；術后5 d觀察組IL-6和TNF-α水平均較對照組更低，但觀察組IL-10水平較對照組更高（Plt;0.05）。觀察組術中出血量少于對照組，骨折愈合時間短于對照組（Plt;0.05）；兩組手術時間比較，差異無統計學意義（Pgt;0.05）。觀察組優良率為93.33%，顯著高于對照組的73.33%（字2=4.320，P=0.038）。觀察組并發癥發生率（3.33%）低于對照組（16.67%），但兩組比較，差異無統計學意義（字2=1.667，P=0.967）。結論：帶線錨釘Krackow縫合法治療Rockwood Ⅲ型髕骨骨折較傳統髕骨爪內固定術的臨床效果更好，能降低術中出血量，加快患者恢復。

【關鍵詞】 髕骨骨折 髕骨爪 Rockwood Ⅲ型 帶線錨釘 Krackow縫合

Clinical Study on the Treatment of Rockwood Type Ⅲ Patellar Fracture by Krackow Suture with Suture Anchor/LIU Shuanglai， ZHAO Weixia， WAN Meirong. //Medical Innovation of China， 2023， 20（31）： 0-032

[Abstract] Objective： To investigate the clinical effect of Rockwood type Ⅲ patellar fracture by Krackow suture with suture anchor. Method： A total of 60 patients with Rockwood type Ⅲ patellar fracture admitted to the Department of Orthopedics of Jiangxi Jiayou Shuguang Orthopaedic Hospital from January 2020 to April 2022 were selected as the study objects， and were divided into observation group （n=30） and control group （n=30） according to random number table method. The control group was treated with internal fixation with patellar claw， and the observation group was treated with Krackow suture with suture anchor. The Bostman patellar fracture function scores before and 2， 4 and 8 months after surgery and the visual analogue scale （VAS） scores before and 1 week， 2 weeks and 1 month after surgery were compared between the two groups. The levels of interleukin-6 （IL-6）， interleukin-10 （IL-10） and tumor necrosis factor-α （TNF-α） were compared between the two groups before and 5 days after surgery. The operation status， clinical efficacy and complications were compared between the two groups. Result： The Bostman patellar fracture function scores in the observation group were higher than those in the control group at 2 and 4 months after surgery， and the VAS scores in the observation group were lower than those in the control group at 1 week and 2 weeks after surgery （Plt;0.05）. There were no significant differences in the levels of IL-6， IL-10 and TNF-α between two groups before surgery （Pgt;0.05）. 5 days after surgery， the levels of IL-6 and TNF-α in the observation group were lower than those in the control group， and the level of IL-10 in the observation group was higher than that in the control group （Plt;0.05）. The intraoperative bleeding volume and fracture healing time of observation group were shorter than those of control group （Plt;0.05）. There was no significant difference in operation time between the two groups （Pgt;0.05）. The excellent and good rate of the observation group was 93.33%， which was significantly higher than 73.33% of the control group （字2=4.320， P=0.038）. The incidence of complications in the observation group （3.33%） was lower than that in the control group （16.67%）， but there was no significant difference between the two groups （字2=1.667， P=0.967）. Conclusion： Compared with internal fixation with patellar claw， Krackow suture with suture anchor has better clinical effect in the treatment of Rockwood type Ⅲ patellar fracture， which can reduce intraoperative bleeding volume and accelerate patient recovery.

[Key words] Patellar fracture Patellar claw Rockwood type Ⅲ Suture anchor Krackow suture

First-author's address： Jiangxi Jiayou Shuguang Orthopaedic Hospital， Nanchang 333000， China

doi：10.3969/j.issn.1674-4985.2023.31.007

髕骨骨折（patellar fracture）為常見損傷，以髕骨周圍腫脹、疼痛、膝關節不能自主伸直為主要表現，常有皮下瘀斑及膝部皮膚擦傷[1]。髕骨骨折多發于男性，其中Rockwood Ⅲ型髕骨骨折最為常見[2-3]，此類骨折伸膝裝置斷裂，骨折塊多粉碎、移位明顯，且因骨折部位在膝蓋下部或下極，導致骨折復位及內固定難度大[4-5]?！?br>