The Clinical Research Of Surgery With Compressive Hollow Screws And Tension Band Wire To Treat Patellar Fracture

Objective: This topic screened12cases of patellar fracture patients sinceJune2011-June2013who were treated by compressive hollow screws andtension band wire in our hospital, and compared with the same period treated11cases Kirschner wire tension band. By observing the aspects of the woundhealing, fracture healing, joint function and so on to evaluate the surgicalmethod, providing a reference for a way to improve clinical treatment ofpatellar fracture surgery, and exploring the issues related to the treatment ofpatellar fracture.Subjects and Methods:23cases of patellar fracture patients in thesubjects were all treated in Hebei Medical University Third Hospital periodfrom June2011-June2013, all patients were fresh closed fractures. Fracturescategory about bone fragments and fracture line: transverse fracture in15cases, comminuted fracture (3bones) in8cases. The Hollow screw tensionband group of12patients were treated by invasive surgery with fixation ofcompressive hollow screws and tension band wire, include transverse fracturein8cases and comminuted fracture(3bones) in4cases; The Kirschner wiretension band group of11patients were treated with fixation of Kirschner wiretension band in transverse curved incision, include transverse fracture in7cases and comminuted fracture(3bones) in4cases.Surgical methods:①The Hollow screw tension band group: Resettingpatellar fracture with needle nose reset pliers, and using the C-arm tofluoroscopy whether the resetting was satisfactory, then two3.5mmcompressive hollow screws guide pins were penetrated perpendicular tofracture site. Cutting a1cm length incision beside the penetration and remotepoint of the pins (For the patients whose fracture displacement was large andclosed reduction was difficult, making a pre-patellar median longitudinal incision, about5~8cm, cutting the deep fascia to separate the sides,exposuring patellar fascia, clearing congestion and broken pieces of soft tissue,and to reveal the fracture sites to open reduction). Screwing into the screwsafter after measuring it’s length. A0.8mm wire was passed the hollow tunneland folded in front of patellar proximal periosteum with a special wire guide,which was connected to the distal end of patella, locking and cutting off theexcess wire (The comminuted fracture cases in which fixation was instabilityneed fixing two small bone with a hollow screw, forming a simple transversefractures). Check the articular surface was neat, joint function was good andinternal fixation was stability, and then sutured the incision.②The Kirschnerwire tension band group: Using a traditional anterior transverse curvedincision, cutting the deep fascia to separate the sides for exposuring thepre-patellar fascia. Resetting patellar fracture with needle nose reset pliers andusing the C-arm to fluoroscopy whether the resetting was satisfactory, thentwo2.0mm Kirschners were penetrated perpendicular to fracture site. One0.8mm wire around the Kirschner to establish tension band and connected tothe distal end of patella, locking and cutting off the excess wire suturing theincision.All patients were followed up after surgery, observed and recorded thehealing time, healing time, knee function recovery of them. Applicatingstatisticl software SPSS16.0to statistical analysis, using a t test to analysisdate of the incision healing time, using a chi-square test to analysis the date ofrate of fracture healing3months after surgery, using a rank sum test toanalysis excellent rate of the knee function after fracture healing, and P＜0.05with a statistical significance, comparing the advantages anddisadvantages of the two surgical methods.Results: All subjects were followed up for6to18months, an average of12months. During follow-up, the incision of all patients were all first divisionhealed; Fractures of the Hollow screw tension band group were all achievedclinical healing, the fixation of2cases in the Kirschner wire tension bandgroup had slipped and loosened who had been re-fixed，and reviewed3months later: fixation without loosening, fracture lines was blur. Compared two groupsof patients, the wound healing time in the Hollow screw tension band groupwas less than the Kirschner wire tension band group; Fracture healing rate3months after surgery in the Hollow screw tension band group was higher thanthe Kirschner wire tension band group; Using Bostman patella fracturefunction score, excellent rate of knee function after fracture healing in theHollow screw tension band group was higher than the Kirschner wire tensionband group.Conclusion:①Surgery with compressive hollow screws and tensionband wire to treat transverse and comminuted patellar fracture was smallincision, conducive to wound healing；②Surgical trauma was small whichreduced injuries to the soft tissue and the blood supply around the fracture,which conductive to fracture healing.;③The internal fixation was solid andstable, effectively preventing displacement and loosness of internal fixation,which helping for early joint function exercise in patients, improving recoveryof limb function. The operation was a simple and effective surgical method.