| Objective Patella is the biggest sesamoid bone inside the human body, locating the inside of quadriceps tendon. It is an important module in the knee extension system. The fracture of patella is common, about 1.6% in human bone fracture. It belongs to the bone fracture inside the articulation, is easy to make the defect on the articular surface, bringing the dysfunction of the joint and trauma arthritis, usually need the surgical operation treatment. There are many methods of internal fixation. AO tension band technique is considered as the classic treatment to do with the fracture of patella including the transverse fracture, but can't achieve the satisfied effect with coronal fracture and the comminuted fracture; its complication is also a clinical common familiar problem to conquer.Recent years TiNi shape memory alloy was applied widely in the clinic because of the special property, TiNi patellar concentrator (NT-PC) often use to treat patella fracture especially in comminuted fracture and get the good effect. AO tension band and the NT-PC become dominant gradually in treating patella fracture. This paper discusses their similarities and differences by the comparison of mechanics experiment and clinical observation.Method This research is divided into two parts: one is the mechanics experiment coming to compare the NT-PC to AO tension band in the fixation of the patellar transverse fracture. Eight fresh adult cadaver legs were involved, including about 40cm femur and 19cm tibias and reserving quadriceps and articular capsule. Double plastic bag seals completely, reserving by the ice cabinet, then defrost in the room temperature, being observed by naked eye and the X-ray expels the bone substance breakage and degenerative arthritis, subsequently sew the patella result in the transverse bone fracture model in the middle point of patella. It is placed in the self-made experimental device, using the specially made tongs to fix the quadriceps, keen joint flexing and extending normally and easily, the specimen was fixed by the NT- PC and AO tension band. The tibia adds to pressure, the high accuracy digital displacement machine affix in the two side of the patella fracture line. The force exerted on the tibia, the distance of fracture displacement and the degree of keen joint flexing was noted. All data was analyzed by the statistics software.Another part is to compare the clinical information of patients who suffered patellar fracture , treated by AO tension band and NT-PC in our hospital from Aug. 1998 to Feb. 2003.all cases age from 19 to 80 years old(average 45 years old); 47 cases of male, 31 cases of female, involving 41 cases of transverse fracture of patella,17 cases of oblique fracture,1 case of longitudinal fracture,13 cases of comminuted fracture,5 cases of sleeve fracture(all occurred in the inferior pole),1 case of coronal fracture.35 fractures occurred in right and 43 in left.69 cases was closed and 9 open. Much of fractures were made by the high-energy trauma, 36 cases by traffic accident, 24 cases during a fall onto the knee, 9 cases by a direct blow and 9 cases by other reasons. 9 cases combining brain trauma; 4 cases combining fracture of femur; 1 case combining fracture of collarbone; 1 case combining multiple fracture. The time of operation is within 8 days after trauma, average for 2.3 days. None was delay to treat.42 cases were treated by NT-PC and 36 by AO tension band. The time of follow-up varied from 6 to 14 months, average was 10 months,64 cases' follow-up are available and 14 cases lost.Antibiotic was applied after operation. The time varied from 3 to 14 days, average was 6 days. No external fixation was used except for comminuted fracture. The quadriceps contraction and relaxation practice were available in all the patients from the next day after the operation. Patients were applied AO tension band began to do exercise of knee joint flexion and extension and weight loading exercise after 2 weeks. Patients were treated by NT-PC do weight loading exercise fro... |
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