经皮微创钛缆内固定治疗髌骨骨折的效果及对患者应激反应、骨代谢指标的影响

王昶

[摘要] 目的 探讨经皮微创钛缆内固定治疗髌骨骨折的效果及对患者应激反应、骨代谢指标的影响。 方法 选取我院自2018年1月至2020年1月收治的77例髌骨骨折患者，按照术式的不同分为对照组38例、观察组39例。对照组给予传统切开复位术治疗，观察组给予经皮微创钛缆内固定术治疗，比较两组一般手术指标、并发症、应激反应指标、骨代谢指标。 结果 观察组手术时间、出血量、术后住院时间、骨折愈合时间少于对照组（P<0.05）;观察组并发症总发生率为12.82%，低于对照组的34.21%（P<0.05）;观察组膝关节功能评分在术后15 d[（65.21±5.97）分 vs （56.47±6.23）分]、术后1个月[（70.28±4.96）分 vs （61.65±5.17）分]、术后3个月[（82.68±3.25）分 vs（77.62±4.02）分]时高于对照组（P<0.05）;术后24 h，观察组血清Cor[（13.82±2.02）ng/mL vs （21.36±3.79）ng/mL]、PGE2[（131.25±17.64）pg/mL vs （162.49±21.05）pg/mL]、E [（35.02±6.37）ng/mL vs （60.63±7.59）ng/mL]、NE[（45.65±5.22）ng/mL vs （76.94±7.06）ng/mL]水平低于对照组（P<0.05）;术后24 h，观察组血清OC[（6.30±0.74）μg/L vs （5.28±0.71）μg/L]、PⅠNP[（38.52±6.09）ng/mL vs（23.19±3.57）ng/mL]水平高于对照组（P<0.05），CTX-Ⅰ [（312.07±50.36）pg/mL vs（558.39±62.98）pg/mL]、CTX-Ⅱ[（211.45±32.18）pg/mL vs （342.62±40.92）pg/mL]水平低于對照组（P<0.05）。 结论 经皮微创钛缆内固定治疗髌骨骨折创伤小，术后并发症少，可明显改善膝关节功能，减轻应激反应，改善术后骨代谢。

[关键词] 经皮微创钛缆内固定;髌骨骨折;膝关节功能;应激反应;骨代谢

[中图分类号] R687.3          [文献标识码] A          [文章编号] 1673-9701（2021）09-0010-04

The effect of percutaneous minimally invasive titanium cable internal fixation in the treatment of patella fractures and its influence on patients′ stress response and bone metabolism indexes

WANG Chang

Department of Orthopedics， the 963rd Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army， Jiamusi   154002， China

[Abstract] Objective To investigate the effect of percutaneous minimally invasive titanium cable internal fixation in the treatment of patella fractures and its influence on patients′ stress response and bone metabolism indexes. Methods A total of 77 patients with patella fractures admitted to our hospital from January 2018 to January 2020 were selected and divided into the control group（38 cases） and the observation group（39 cases） according to different surgical procedures. The control group was treated with traditional open reduction， and the observation group was treated with percutaneous minimally invasive titanium cable internal fixation. The general surgical indicators， complications， stress response indicators， and bone metabolism indicators between the two groups were compared. Results The operation time， blood loss， postoperative hospital stay， and fracture healing time in the observation group were less than those in the control group（P<0.05）. The total incidence of complications in the observation group was 12.82%， which was lower than 34.21% in the control group（P<0.05）. The knee joint function scores of the observation group at 15 days， one month， and three months after the operation were higher than those of the control group（[65.21±5.97] points vs [56.47±6.23]points， [70.28±4.96] points vs [61.65±5.17] points， [82.68±3.25] points vs [77.62±4.02] points）（P<0.05）. 24 h after operation， the serum Cor （[13.82±2.02] ng/mL vs [21.36±3.79] ng/mL）， PGE2（[131.25±17.64] pg/mL vs [162.49±21.05] pg/mL）， E（[35.02±6.37] ng/mL vs [60.63±7.59] ng/mL）， NE（[45.65±5.22] ng/mL vs [76.94±7.06] ng/mL） levels in the observation group were lower than those of the control group（P<0.05）. The serum OC （[6.30±0.74]μg/L vs [5.28±0.71]μg/L）， PⅠNP （[38.52±6.09]ng/mL vs [23.19±3.57]ng/mL） of the observation group were higher than those of the control group（P<0.05）. The CTX-Ⅰ （[312.07±50.36] pg/mL vs [558.39±62.98] pg/mL）， CTX-Ⅱ （[211.45±32.18]pg/mL vs [342.62±40.92]pg/mL） of the observation group were lower than those of the control group（P<0.05）. Conclusion Percutaneous minimally invasive titanium cable internal fixation for the treatment of patella fractures has less trauma and fewer postoperative complications. It can significantly improve knee joint function， reduce stress response， and improve postoperative bone metabolism.

[Key words] Percutaneous minimally invasive titanium cable internal fixation; Patella fracture; Knee joint function; Stress response; Bone metabolism

髌骨是膝关节的重要构成部分，在直接或间接暴力作用下容易发生骨折，其发生率占全部骨折的l%左右[1]。髌骨骨折若复位不佳，容易引起创伤性关节炎，影响膝关节功能。而如果选择切除髌骨，将会造成膝关节功能永久性受限，因此髌骨骨折主要治疗目的是保持髌骨完整、良好复位、稳固固定。传统切开复位治疗具有创伤大、出血多、并发症多、术后恢复慢、切口处容易粘连等缺点。同时，传统复位后采用钢丝内固定存在固定可靠性不佳的问题，容易引起钢丝松动、断裂、克氏针脱出等，影响复位效果。经皮微创钛缆内固定为新型内固定方式，钛缆具有较强抗磨损、抗疲劳、抗拉力的能力，固定牢靠，不易发生复位丢失、骨折分离等情况。骨折引起的疼痛、手术创伤所致的疼痛均会不同程度地加重机体应激反应，刺激机体增加分泌皮质醇（Cortisol，Cor）、前列腺素E2（Pro-staglandin E2，PGE2）、肾上腺素（Epinephrine，E）、去甲肾上腺素（Norepinephrine，NE）。……