Sun Yan,Guo Xingqi,Chen Zhifeng,et al.Clinical efficacy of “+” suturing fixation for acute patella dislocation with cartilage fracture in adolescents[J].Journal of Clinical Pediatric Surgery,2019,18(12):1031-1035.[doi:10.3969/j.issn.1671-6353.2019.12.009]
“十”字缝合固定法治疗青少年急性髌骨脱位伴软骨面骨折的临床疗效
- Title:
- Clinical efficacy of “+” suturing fixation for acute patella dislocation with cartilage fracture in adolescents
- 分类号:
- R726.8;R681.8;R681.3
- 摘要:
- 目的 回顾性分析采用"十"字缝合固定法治疗青少年急性髌骨脱位伴软骨面骨折的临床疗效。方法 纳入新邵县中医院2016年5月至2018年5月收治的27例急性髌骨脱位伴软骨面骨折的患儿作为研究对象，均采用不可吸收线"十"字缝合法固定软骨块，联合髌骨内侧支持带紧缩或联合外侧支持带松解术进行治疗，术后定期随访（随访时间均超过1年），观察有无复发脱位情况，并通过髌骨轴位片及恐惧试验检查评估髌骨稳定性；术后1年复查MRI了解软骨骨折愈合情况，采用Lysholm评分系统评价患膝术前及末次随访的膝关节功能。结果 所有患儿伤口愈合良好，伤口无排异反应，无感染情况出现，且未出现再次脱位。X线片检查髌骨轴位片发现7例患儿仍有半脱位状态，4例患儿恐惧试验仍出现弱阳性结果。术后1年复查MRI发现髌软骨块均未脱落，且愈合良好。治疗前Lysholm评分为（36.4+8.3）分，末次复查为（86.3+5.8）分，差异有统计学意义（t=16.83，P=0.02）。结论 采用不可吸收线"十"字缝合固定法治疗急性髌骨脱位伴软骨面骨折疗效显著，值得临床推广。
- Abstract:
- Objective To retrospectively analyze the clinical efficacy of "+" suturing fixation for acute patella dislocation with cartilage fracture in adolescents.Methods A total of 27 children of acute patella dislocation with cartilage fractures were recruited from May 2016 to May 2018.All of them underwent "+" suturing fixation with non-absorbable sutures and medial patella support band tightening or plus lateral support band releasing.Regular postoperative follow-ups were performed.The average follow-up period was 13.4 months.To observe the presence or absence of recurrence dislocation,patella axial films and fear test were performed for assessing the stability of patella.At 1 year postoperation,magnetic resonance imaging (MRI) was re-examined for tracking the healing of cartilage fracture.And the Lysholm score was employed for evaluating the preoperative function of knee and at the last follow-up.Results All of them achieved an excellent wound healing without rejection,infection or complete dislocation of patella.Patella axial films hinted at subluxation (n=7) and fear test was weakly positive (n=4).The instability rate of patella was 26%.At 1 year post-operation,MRI examination showed that no dislodging of patella cartilage block occurred and healing was excellent.The average preoperative Lysholm score was (36.4+8.3) and the last follow-up Lysholm score (86.3+5.8) (t=16.83,P=0.02).And the Lysholm scores improved significantly after treatment and there was statistical significance (P<0.05).Conclusion The methods of "+" suturing fixation with non-absorbable sutures for cartilage fracture of acute patella dislocation is effective and worthy of wider clinical applications.
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备注/Memo
收稿日期:2019-07-29。
通讯作者:陈志峰,Email:157853984@qq.com