| Objective: The past decades have witnessed a phenomenon that with the transportation’s development and construction’s progresses, the incidence of patella fracture, especially the comminuted fracture incidence, is on the rise. The treatment of patellar fracture has experienced a long history. Before the year of 1877, patients developed this fracture were cured by conservative treatment, mainly used a knee holder, lied in bed to have a rest, achieving the second phase of fracture healing by the way of callus formation, which resulted in a severe knee joint dysfunction. In 1877, Cameron treated patellar fracture patients with open reduction method for the first time. The following 100 years, all kinds of internal fixation materials are appearing in the patellar treatment. The classic tension band internal fixation is a classical fixation, but for some comminuted fractures, tension band fixation often appears a higher failure rate and complications. People began to explore and study the proper choice of patellar fracture operation of various types.This study is to explore the clinical curative effection and feasibility of miniature plate of patella fracture, providing a new internal fixation method to the clinical treatments of patellar fracture.Methods: The clinical data from the 23 cases of patellar fracture patients cured in our apartment during in September 2012- September 2014 is retrospectively analyzed. All patients did CT before the operations,and all fractures were closed fresh fractures.The injury time to operation time for 2 hours- 3 days, an average of 1.2 days. All the cases use the patellar Saunders classification categories: transverse fracture in 8 cases and 15 cases in comminuted fracture(3 pieces or more). All the cases are divided into the experimental group and the control group. Both of them were accepted the same incision: the middle of longitudinal incision ahead of patellar. The experimental group: plate was all used to fixed patella in 12 cases, including non-comminuted type fracture(transverse fracture) in 4 cases, comminuted type(3 pieces or more) fractures in 8 cases.The control group: tension band wire was used, including non-comminuted type fracture(transverse fracture) in 4 cases, comminuted type(3 pieces or more) fractures in 7cases.①The miniature plate group: After the anesthesia, by judging patient ’s anesthesia result is satisfactory, the surgeon use iodine、alcohol to disinfect the diagnosed leg, and use the operation sterile list. The diagnosed leg was bended, and the tourniquet must be inflated to 300 mm Hg. The middle of longitudinal incision ahead of patellar was adopted.Then cutting the skin、subcutaneous tissue、 deep fascia and separate it’s sides, and exposing the patellar fascia, and clearing the coagulated blood clots and the broken pieces of soft tissue around the patella.Dotted reset pliers was used to reset the fracture blocks. C-arm are used to fluoroscopy to assure the resetting was satisfactory, after the joint surface and fracture blocks was satisfactory,put the miniature plate above the bone surface, then drill the corresponding hole, and measure the depth, then twist the nail into the corresponding screw hole. Using the Kirschner wires when necessary. Ensuring that the main fracture blocks are covered by miniature plate and screw or the Kirschner wires.Then active the knee joint,if there were abnormal,relax the tourniquet step by step,a thorough hemostasis,then suture a wound step by step. ②The Kirschner wire tension band group: after the anesthesia, by judging patient ’s anesthesia result is satisfactory, the surgeon use iodine、alcohol to disinfect the diagnosed leg, use the operation sterile list. After bending the diagnosed leg, tourniquet must be inflated to 300 mm Hg. The middle of longitudinal incision ahead of patellar was adopted.Cutting the skin and subcutaneous tissue and deep fascia step by step, then separating it’s sides, and exposing the patellar fascia, then clearing coagulated blood clots and the broken pieces of soft tissue around the patella. Reseting the patellar fracture with needle nose reset pliers and use the C-arm to fluoroscopy. If the resetting was satisfactory, then using two 2.0mm Kirschners to fix fracture site together. Then making a 0.8mm wire around both end of Kirschner to establish the tension band, then locking and cuting off the excess wire.Active the knee joint,if there were abnormal,relax the tourniquet step by step,a thorough hemostasis,then suture a wound step by step.Postoperative treatment: all patients accept the same medicines, functional guidances and rehabilitation exercises.Statistical analysis: All the patients ’ date were and recorded, including the seperate healing time of incision, healing time of fracture, the function of knee. Appling statistical analysis software SPSS 16.0 to analysis the associated data,analysis date of the wound healing time by a t test, analysis the date of rate of fracture healing 3months and 6months after the surgery by a chi-square test, analysis the rate of the knee function after fracture healing by a rank sum test, and choose P<0.05 as a statistical significance standard to compare the two clinical fixation methods.Results:1 All patients were followed up for 7 to 16 months, an average of 12 months. The incisions of all patients were all first division healed.There were no significance difference(P>0.05) in the incision healing time between the miniature plate group and The Kirschner wire tension band group.(Table 1)2 There were no significance difference(P>0.05) in patients ’ fracture healing rate between the miniature plate group and The Kirschner wire tension band group.3 Using Bostman knee joint function score, the rate of knee function after fracture healing in the miniature plate group were better than the Kirschner wire tension band group. There were no significance difference(P>0.05) in patients ’ excellent rate of knee function between the transverse fracture type group and the comminuted type group,while there were difference(P<0.05) in patients ’ excellent rate of knee function between the transverse fracture type group and the comminuted fracture type group.Conclusions:1 Two kinds of operation method can be well fixed simple transverse patellar fractures, fracture healing rate in the two groups were similar,2 The size of miniature plate don’t interfere with the wound ’ healing,3 Miniature plate has some advantages over tension band fixation in treating comminuted patellar fractures, and has a better function of knee joint. |
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