不吸收缝线穿骨修复治疗急性髌骨脱位合并髌骨骨软骨骨折的疗效观察

Clinical observation of acute patellar dislocation combined with osteochondral fracture with nonabsorbable suture through transosseous repair

摘要:

目的 探讨不吸收缝线穿骨修复治疗急性髌骨脱位合并髌骨骨软骨骨折（OCFs）的临床疗效。方法 回顾性分析2016年9月－2019年9月该院诊治的17例急性髌骨脱位合并髌骨OCFs患者的临床资料，17例患者均为急性损伤。其中，男8例，女9例；年龄13～39岁，平均20.3岁；左侧10例，右侧7例。记录患者术前术后关节活动范围、单腿跳远测试、大腿周径、视觉模拟评分（VAS）、国际膝关节文献委员会（IKDC）评分和Lysholm膝关节评分。结果 17例患者均获随访，随访时间12～18个月，平均15个月。术后第12个月复查CT显示：所有患者均获得骨性愈合，未出现骨块脱落。末次随访时，IKDC评分、Lysholm膝关节评分和VAS与术前比较，差异均有统计学意义（P < 0.05）。末次随访时，患侧大腿周径、单腿跳远测试和膝关节活动范围与术前健侧比较，差异无统计学意义（P > 0.05）。结论 不吸收缝线穿骨修复治疗急性髌骨脱位合并髌骨OCFs，临床疗效满意，可以获得满意的固定强度，OCFs可得到骨性愈合，且无金属内固定物，无需行二次手术取出，同时还能恢复良好的膝关节功能。

Abstract:

Objective To observe the clinical effect of nonabsorbable suture through transosseous repair in treatment of acute patellar dislocation combined with osteochondral fractures (OCFs).Methods Clinical data of 17 patients with acute patellar dislocation combined with OCFs diagnosed and treated from September 2016 to September 2019 were retrospectively analyzed, including 8 males and 9 females. The age ranged from 13 to 39 years, with an average of 20.3 years. There were 10 cases on the left and 7 cases on the right. Joint range of motion, single-leg long jump, thigh circumference quadriceps circumference, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) and Lysholm knee score were recorded.Results 17 patients were followed up 12~18 months, with an average of 15 months. CT reexamination at 12 months after surgery showed that all patients had osseous union without shedding of bone mass. At the last follow-up, the IKDC score, Lysholm knee score and VAS were significantly different from those before surgery (P < 0.05). At the last follow-up, there were no statistically significant difference in thigh circumference, single-leg long jump test and knee joint range of motion compared with the preoperative healthy side (P > 0.05).Conclusion The treatment of acute patellar dislocation combined with OCFs with nonabsorbable sutures through bone repair has satisfactory clinical efficacy, can obtain satisfactory fixation strength, OCFs can get bone union,no metal implants required secondary surgical removal, and the knee joint function is recovered well.