大家好，我是九楼老王。近期我发现了一系列国外的优质骨科视频，一共40个左右，详细展示了一些基础性的骨科手术的做法，每个大约1分钟，非常适合学习。本文是其中一个，我做了动态截图，用AI适配了讲解，供大家参考。
The Kirschner wire tension band technique is a widely used method for the surgical fixation of patellar fractures, particularly transverse fractures. This procedure aims to restore the extensor mechanism of the knee, achieve anatomical reduction, and provide stable fixation to allow early mobilization. Below are the detailed surgical steps:克氏针张力带技术是广泛用于髌骨骨折手术固定的一种方法，特别是横行骨折。该手术旨在恢复膝关节的伸肌机制，实现解剖复位，并提供稳定的固定以允许早期活动。以下是详细的手术步骤：
1. Preoperative Preparation1. 术前准备
Patient Positioning: Place the patient in a supine position on a radiolucent operating table. 患者体位：将患者置于透射线手术台上仰卧位。
Anesthesia: General or regional anesthesia is administered. 麻醉：采用全身或区域麻醉。
Sterilization and Draping: Prepare the surgical site with antiseptic solution and drape the area to maintain a sterile field. 消毒铺巾：用消毒液准备手术部位，并用无菌巾覆盖以保持无菌环境。
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2. Surgical Exposure2. 手术显露
Incision: Make a midline longitudinal incision over the patella. 切口：在髌骨上方做一正中纵行切口。
Soft Tissue Handling: Carefully dissect through the subcutaneous tissue to expose the patella while preserving the surrounding soft tissues, including the retinaculum. 软组织处理：小心分离皮下组织以显露髌骨，同时保护周围的软组织，包括髌韧带。
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3. Fracture Reduction3. 骨折复位
Debridement: Remove any hematoma, debris, or interposed soft tissue from the fracture site. 清创术：清除骨折部位的任何血肿、碎屑或嵌入的软组织。
Reduction: Manually reduce the fracture fragments to achieve anatomical alignment. Temporary fixation with reduction clamps or small K-wires may be used to hold the fragments in place. 复位：手动将骨折碎片复位以达到解剖对位。可使用复位钳或小克氏针进行临时固定，以保持碎片位置 。
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4. Placement of Kirschner Wires4. 克氏针放置
Insertion: Insert two parallel K-wires (1.6–2.0 mm in diameter) longitudinally across the fracture site. The wires should be placed approximately 5 mm from the anterior cortical surface of the patella and parallel in both the coronal and sagittal planes. 插入：将两根平行克氏针（直径 1.6–2.0 mm）纵向穿过骨折部位。针应放置在髌骨前皮质表面约 5 mm 处，并在冠状面和矢状面平行。
Positioning: Ensure the wires penetrate the distal and proximal poles of the patella without exiting the soft tissue excessively to avoid irritation or complications. 定位：确保导线穿透髌骨的远端和近端极，但不过度穿出软组织，以避免刺激或并发症。
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5. Application of Tension Band5. 张力带的应用
Wire Looping: Pass a stainless steel cerclage wire (usually 18-gauge) in a figure-of-eight configuration around the K-wires. The wire should loop anteriorly over the patella and posteriorly through the quadriceps and patellar tendons. 钢丝环扎：以 8 字形配置将一根不锈钢环扎钢丝（通常为 18 号）绕过 K 型钢针。钢丝应在前方绕过髌骨，并在后方穿过股四头肌和髌腱。
Tensioning: Tighten the cerclage wire evenly using a tensioning device or twisting technique to compress the fracture fragments. This converts tensile forces from the extensor mechanism into compressive forces at the fracture site. 张力施加：使用张力装置或扭转技术均匀地拉紧环扎钢丝，以压缩骨折碎片。这将从伸肌机制产生的拉力转化为骨折部位的压缩力。
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6. Verification of Fixation6. 固定验证
Stability Check: Confirm the stability of the fixation by flexing and extending the knee intraoperatively. Ensure the fracture remains reduced and the fixation is stable. 稳定性检查：术中通过屈伸膝关节确认固定稳定性。确保骨折复位保持良好且固定稳定。
Imaging: Use intraoperative fluoroscopy to verify proper alignment of the fracture, correct placement of the K-wires, and adequate tension in the cerclage wire. 影像学检查：术中透视以验证骨折的正确对位、K 线钉的准确放置以及环扎钢丝的适当张力。
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7. Final Steps7. 最后步骤
Trimming Wires: Cut and bend the ends of the K-wires to prevent migration. Ensure the ends are buried beneath the soft tissue to minimize irritation. 修剪钢丝：剪短并弯曲 K 型钢丝的末端以防止移位。确保末端埋入软组织下以减少刺激。
Closure: Close the retinaculum and soft tissues in layers. Use absorbable sutures for deeper layers and non-absorbable sutures for the skin. 关闭：逐层关闭支持带和软组织。深层使用可吸收缝线，皮肤使用不可吸收缝线。
Dressing: Apply a sterile dressing and immobilize the knee in extension using a brace or splint. 敷料：应用无菌敷料并用支具或夹板将膝关节固定于伸直位。
8. Postoperative Care8. 术后护理
Rehabilitation: Early range-of-motion exercises are typically initiated within 1–2 weeks postoperatively, depending on the stability of the fixation and the surgeon's preference. 康复：通常在术后 1-2 周内开始进行早期关节活动度锻炼，具体取决于固定稳定性及外科医生的偏好。
Follow-Up: Regular radiographic evaluations are performed to monitor fracture healing and implant position. 随访：定期进行放射学评估，以监测骨折愈合及植入物位置。
Key Considerations关键考虑因素
The modified K-wire tension band technique is effective but may have complications such as wire migration, skin irritation, or the need for hardware removal in up to 30–52% of cases. 改良 克氏针张力带技术虽有效，但可能出现如钢丝移位、皮肤刺激或高达 30–52%病例需行内固定物取出等并发症。
Alternative techniques, such as using suture materials or anti-rotation strategies, may be considered for specific fracture patterns or to reduce complications. 可考虑采用替代技术，如使用缝合材料或抗旋转策略，以针对特定骨折类型或减少并发症。
This method remains a gold standard for patellar fracture fixation due to its simplicity, cost-effectiveness, and reliable outcomes.该方法因其简便性、成本效益和可靠的结果，仍然是髌骨骨折固定的金标准。
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