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1、142中国骨伤2003年3月第16卷第3期ChinaJOrthop&Trauma,Mar2003,Vol.16,No.3论著手术与保守方法治疗髌骨骨折疗效比较徐飞朱亚平(常州市第一人民医院,江苏常州213003)摘要!目的探讨髌骨骨折的手术治疗和手法治疗的优缺点。方法根据患者的X线片和术中所见,将手术组和保守组各13例分为横断粉碎型和星状崩裂型两大类,分别采用切开复位张力带内固定加CPM机膝关节功能锻炼,和手法复位自制髌圈加石膏托外固定加中药熏洗,二组均随访半年以上。结果对两大类型髌骨骨
2、折的治疗总治愈率,手术治疗769%显著优于保守治疗538%(P<005),但总有效率,手术治疗为923%,保守治疗为100%,两法相比又无显著差异(P>005),其中对横断粉碎型骨折的治愈率,西医组为100%,中医组为50%;对星状崩裂型,手术组为40%,保守组为571%。结论对横断粉碎型髌骨骨折,特别是断端分离超过2cm者,应采用手术治疗;而对星状崩裂型,特别是全髌粉碎型,可考虑用手法治疗。关键词!髌骨;骨折;外科手术;正骨手法Acomparisonofconservativeandope
3、rativetreatmentforthepatellarfractureXUFei,ZHUYaping.TheFirstPeoplesHospitalofChangzhuo(JiangsuChangzhou,213003,China)Abstract!ObjectiveToinvestigatetheadvantageanddefectofoperationandtraditionalChinesemanipulationintreatingthepatellarfractureMethodsAccord
4、ingtothepatientsXrayandwhatwasseeninoperation,thecasesweredividedintotwogroups,includingthesurgicalgroup(SG)andmaneuvergroup(MG).Eachgrouphad13cases,whichwasdividedintotwotypes,includingthetransversecomminutedfractureandthestellatecrackedfracture.Openreduc
5、tionandtensilebandinternalfixationwereusedandCPMfollowedinSG.Handskillreductionandpatellacirclemadebyauthorhimself,plastersupportexternalfixationandChineseherbsfumigatingwereusedinMG.Thecasesintwogroupswerefollowedupformorethanhalfayear.ResultsThetotalcurati
6、veratiooftreatingthesetwopatellarfracturetypesinSGwas769%,superiortoMGs538%(P<005).ThetotaleffectiverateinSGwas923%and100%inMGs,respectively.Therewerenosignificantdifferenceinthesetwoways(P>005).Thecurativeratiointransversecomminutedfracturewas100%inS
7、Gand50%inMC.Inthemeanwhile,tostellatecrackedfracture,thecurativeratiowas40%inSGand571%inMG.ConclusionIntransversecomminutedpatellarfracture,especiallythelengthofendseparationexceeded2cm,operationshouldbeused.Tothosestellatecrackedfracture,especiallytothetot
8、alpatellarcomminutedtypes,wemayusehandskilltotreatthem.Keywords!Patellar;Fractures;Surgery,operative;Bonesettingmanipulation髌骨骨折是临床常见的急性膝部损伤。我院自两组的骨折类型及例数,我们按患者的X线片1988年1月-2001年1月分别
