髌骨骨折的治疗现状及进展
摘要
髌骨是人体最大的籽骨，髌骨与股四头肌腱膜、髌旁腱膜、髌韧带共同构成伸膝装置。髌骨骨 折多由直接暴力或间接暴力引起。根据骨折类型的不同，治疗方法包括保守治疗或手术治疗。对于无移位且伸 膝装置完整的髌骨骨折，可采用非手术治疗的方式。对于伸膝装置功能障碍、关节面台阶大于 2 ～ 3 mm 或骨 折分离大于 4 mm 的髌骨骨折，建议行手术治疗。手术固定的方式包括了张力带固定、螺钉内固定、接骨板内 固定、髌骨切除等方式。其中，张力带技术是髌骨骨折手术治疗中应用最广泛的治疗方法之一。若由于内置入 物引起相关疼痛，骨折愈合后常须取出内固定装置。粉碎性髌骨骨折手术治疗对骨科医师来说是一个治疗的临 床难点。本文旨在综述当前的髌骨骨折的治疗策略，阐述髌骨骨折患者的综合治疗方式。参考
[1]Dan M, Parr W, Broe D, Cross M, Walsh WR.
Biomechanics of the knee extensor mechanism and its
relationship to patella tendinopathy: A review. J Orthop
Res. 2018;36(12):3105-3112.
[2]Yoo JH, Yi SR, Kim JH. The geometry of patella
and patellar tendon measured on knee MRI. Surg Radiol
Anat. 2007;29(8):623-628.
[3]Melvin JS, Mehta S. Patellar fractures in adults. J
Am Acad Orthop Surg. 2011,19(4):198–207.
[4]Reul M, Verschaeve M, Mennes T, Nijs S,
Hoekstra H. Functional outcome and economic burden of
operative management of patellar fractures: the pivotal role
of onerous implants. Eur J Trauma Emerg Surg 2018,44-
5:697-706.
[5]Sayum Filho J, Lenza M, Teixeira de Carvalho R,
Pires OG, Cohen M, Belloti JC. Interventions for treating
fractures of the patella in adults.Cochrane Database Syst
Rev. 2015,(2):CD009651.
[6]Hambright DS, Walley KC, Hall A, Appleton
PT, Rodriguez EK. Revisiting Tension Band Fixation
for Difficult Patellar Fractures.J Orthop Trauma.
2017,31(2):e66-e72.
[7]Camarda L, La Gattuta A, Butera M, Siragusa
F, D’Arienzo M. FiberWire tension band for patellar
fractures. J Orthop Traumatol. 2016,17(1):75–80.
[8]LeBrun CT, Langford JR, Sagi HC. Functional
outcomes after operatively treated patella fractures. J
Orthop Trauma. 2012,26(7):422–6.
[9]Hoshino CM, Tran W, Tiberi JV, III, Black MH,
Li BH, Gold SM, et al. Complications following tensionband fixation of patellar fractures with cannulated screws
compared with Kirschner wires. J Bone Joint Surg Am.
2013,95(7):653–9.
[10]Luna-Pizarro D, Amato D, Arellano F,
Hernández A, López-Rojas P. Comparison of a
technique using a new percutaneous osteosynthesis device
with conventional open surgery for displaced patella
fractures in a randomized controlled trial.J Orthop Trauma.
2006,20(8):529-535.
[11] Zha K, Liu GH, Yang SH, Zhou W, Liu Y,
Wu QP. Cable pin system versus K-wire tension band
fixation for patella fractures in Chinese Han population: A
meta-analysis. J Huazhong Univ Sci Technolog Med Sci.
2017;37(5):667-674.
[12] Mao N, Ni H, Ding W, et al. Surgical treatment
of transverse patella fractures by the cable pin system with a
minimally invasive technique. J Trauma Acute Care Surg.
2012;72(4):1056-1061.
[13] Yang L, Yueping O, Wen Y. Management of
displaced comminuted patellar fracture with titanium cable
cerclage. Knee. 2010;17(4):283-286.
[14] Huang SL, Xue JL, Gao ZQ. Management of
patellar fracture with titanium cable cerclage. Medicine
(Baltimore). 2017;96:e8525.
[15] Sun Y, Sheng K, Li Q, Wang D, Zhou D.
Management of comminuted patellar fracture fixation
using modified cerclage wiring. J Orthop Surg Res.
2019;14(1):324.
[16] Taylor BC, Mehta S, Castaneda J, French BG,
Blanchard C. Plating of patella fractures: techniques and
outcomes. J Orthop Trauma. 2014; 28(9):e231- e235.
[17] Wurm S, Augat P, Bühren V. Biomechanical
Assessment of Locked Plating for the Fixation of Patella
Fractures.J Orthop Trauma. 2015;29(9):e305-e308.
[18] Thelen S, Schneppendahl J, Jopen E, et al.
Biomechanical cadaver testing of a fixed-angle plate
in comparison to tension wiring and screw fixation in
transverse patella fractures. Injury. 2012; 43(8):1290-1295.
[19] Banks KE, Ambrose CG, Wheeless JS, Tissue
CM, Sen M. An alternative patellar fracture fixation: a
biomechanical study. J Orthop Trauma. 2013; 27(6):345-
351.
[20] Gwinner C, Märdian S, Schwabe P, Schaser KD,
Krapohl BD, Jung TM. Current concepts review: Fractures
of the patella. GMS Interdiscip Plast Reconstr Surg
DGPW. 2016; 5: Doc01.
[21] Oh HK, Choo SK, Kim JW, Lee M. Internal
fixation of displaced inferior pole of the patella fractures
using vertical wiring augmented with Krachow suturing.
Injury 2015;46-12:2512-5.
[22] Carpenter JE, Kasman R, Matthews LS. Fractures
of the patella. J Bone Joint Surg Am. 1993;75(10):1550–
61.
