关节片剥离和分离固定用于治疗带有冠状分裂关节片的粉碎性髌骨骨折:关节分离技术。

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2024-06-01 Epub Date: 2024-04-08 DOI:10.4055/cios23302
Kyu-Hyun Yang, Hyunik Cho, Daewon Kim, Young-Chang Park
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引用次数: 0

摘要

背景:髌骨粉碎性骨折伴有冠状劈裂关节和下极碎片的治疗是一项挑战。为了治疗这种棘手的骨折,我们对冠状裂开的关节和下极碎片进行了关节碎片分离和分离固定。我们旨在评估我们的技术在粉碎性髌骨骨折术后至少一年的放射学和临床效果:方法:2019 年 1 月至 2022 年 6 月期间,15 名根据术前计算机断层扫描确诊为髌骨粉碎性骨折并伴有冠状劈裂关节和下极碎片的患者接受了关节分离技术手术。该技术的要点是在将冠状劈裂的关节片与下极完全分离后,对冠状劈裂的关节片进行解剖复位和软骨下固定。剩余的下极使用单独的结构进行固定。术后关节间隙、关节脱出和并发症,包括固定关节片的吸收、减少和血管性坏死,均作为放射学结果进行评估。活动范围和 Lysholm 评分用于评估临床结果:在15名患者中,13名患者使用Kirschner钢丝固定冠状劈裂关节片,2名患者使用无头螺钉固定。13名患者使用单独的垂直接线固定下极,2名患者使用拉力带接线。7名患者术后出现关节间隙,平均间隙为1.0毫米(范围为0.7-1.6毫米)。未发现关节间隙。所有患者都实现了骨结合和正常活动范围。术后 1 年的侧位X光片显示,5 名患者的关节骨折部位出现吸收。冠状劈裂的关节碎片没有出现缩小或血管性坏死。术后一年的平均 Lysholm 评分为 89.3 ± 4.1(范围为 82-95):结论:对于伴有冠状劈裂关节和下极碎片的粉碎性髌骨骨折的手术治疗,该技术是一种可靠、安全的选择,既能解剖复位,又能稳定固定关节碎片,且无血管坏死风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Articular Fragment Detachment and Separate Fixation for the Treatment of Comminuted Patellar Fractures with Coronal Split Articular Fragments: Articular Detachment Technique.

Background: Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery.

Methods: Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes.

Results: Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95).

Conclusions: The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.

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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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