The Clinical Observation Of The Treatment Of Patella Fracture With New Reduction Method And Cannulated Screws Internal Fixation

Objectives: Introduce the reduction and internal fixation technology ofthe patella fracture with cannulated screws, wih the ivestigation and analysisof100cases of patellar fracture patients which were treated by Orthopedicsand Traumatology Department2009-2011.Evaluate the advantages anddisadvantages of cannulated screws fixation of patellar fracture comparatively.Provide reference and guidance for the clinical treatment.Methods: Admitted to the100cases of patella fracture inpatients whichwere treated in Orthopedics and Traumatology Ward of theThird Hospital ofHebei Medical University2009-2011.including transverse fracture53cases(cannulated screws group18cases,Kirschner's wire tension band group35cases), comminuted fracture47cases(cannulated screws group17cases,Kirschner's wire tension band group30cases).1closed reduction and cannulated screw fixation in transverse fracturesgroup:reset the fracture with the reset clamp, under the perspective of theX-ray machine.Fast the reset clamp after the articular surface is satisfied.Flexthe knee40°, position the three guide pins from the patella on the pole, thetwo guide pin is located in the patella tension by the force side, the middle ofthe guide pin in the center of the pressure.Then measure the depth,length ofthe screw is appropriate when the screw head just penetrate the contralateralcortex of the bone.Pull out the guide pin,and dress the wounds withBand-Aids.2Open reduction and cannulated screw fixation in transverse fractures group：Cut the skin with curved incision in the prepatellar, then expose the fracturefragments.Reset the fracture with the mark of the front surface of thepatella,reset the fracture with fingers necessarily.After checking the patellar articular surface is satisfied, penetrate two Kirschner wires in diameter of2mm since the end of the patella to the tip. Wrapped around each Kirschnerwire circle,with the wire. Tie the knot in the end of the patella.3Reversed reduction and cannulated screw fixation in comminuted fracturesgroup:Cut the skin with curved incision in the medial.Cut the medial patellarretinaculum,and reset the articular surface under the eye observation.Fix eachfracture fragment to the direction of the center.After measuring thedepth,Screw the cannulated screws.Bone quantity,decided the number of thescrew.The larger bone fragments must have been fixed.The strong degree ofthe decision decide whether the secondary fixation is necessary. Repair themedial patellar retinaculum,after the fixion is completed.4Open reduction and Kirschner's wire tension band fixation in comminutedfractures group：Cut the skin with curved incision in the prepatellar, thenexpose the fracture fragments.Reset the fracture with the mark of the frontsurface of the patella,reset the fracture with fingers necessarily.After checkingthe patellar articular surface is satisfied, penetrate two Kirschner wires indiameter of2mm since the end of the patella to the tip. Wrapped around eachKirschner wire circle,with the wire. Tie the knot in the end of the patella. TheKirschner wires should be parallel or cross,it depends on the fracture blocks'location.It must be sure that the major fractures have been fixed. Wrappedaround each Kirschner wire circle,with the wire. Tie the knot in the end of thepatella. The strong degree of the decision decide whether the secondaryfixation is necessary.Analysis the length of the incision,the operation time, the the rate offracture healing3months after surgery and the knee function of the twotreatments in the transverse fractures group and comminuted fractures group.and applicate statistical software SPSS15.0to statistical analysis, using achi-square test to analysis the date of rate of fracture healing3months aftersurgery and the knee function, and a t test to analysis the date of the length ofthe incision and the operation time, P <0.05with a statistical significance. Results: In the53cases of the transverse fracture group,both the lengthof the incision and the operation time in cannulated screws group are less thanKirschner's wire tension band group; The the rate of fracture healing3monthsafter surgery of cannulated screws group is higher than Kirschner's wiretension band group. The knee function of the two groups have no significantdifference. In the47cases of the comminuted fracture group, the length of theincision and the operation time of the cannulated screws group are both lessthan Kirschner's wire tension band group. The rate of fracture healing3months after surgery and the knee function of the two groups have nosignificant difference.Conclusions:1Closed reduction and cannulated screw fixation technique has obviousadvantages in the treatment of patellar transverse fracture：less trauma,shorter operation time, with shorter healing time, however knee function.2Reversed reduction and cannulated screw fixation technique has theadvantages in the treatment of the comminuted patella fracture.3New reduction method and cannulated screws internal fixation technique..