拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折  

Internal fixation with lag screws plus an auxiliary anti-sliding plate for the treatment of Hoffa fractures

作　　者：徐培[1] 孙杰[2] 袁天祥[2] 马宝通[2] 

机构地区：[1]河北省廊坊市霸州第二医院骨科,065701 [2]天津医院创伤骨科

出　　处：《中华创伤骨科杂志》2012年第11期927-930,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折的疗效。方法回顾性分析2007年12月至2011年11月手术治疗的12例（14髁）Hoffa骨折患者资料，男8例（10髁），女4例（4髁）；年龄20-61岁，平均36．2岁。Hoffa骨折类型：内髁骨折6例，外髁骨折4例，双髁骨折2例。骨折按AO／OTA分型：33832型10例，33833型2例；按Letenneur分型：I型7髁，Ⅱ型1髁，Ⅲ型6髁。开放性骨折2例，闭合性骨折10例。合并伤：股骨干骨折1例，胫骨近端骨折3例，踝部骨折1例，伸膝装置损伤2例，交叉韧带损伤4例，内侧副韧带损伤1例，半月板损伤3例。受伤至手术时间平均为3．2d（2h至7d）。所有患者均采用松质骨拉力螺钉结合抗滑钢板固定治疗。结果12例患者术后获6-54个月（平均20．3个月）随访。骨折均获骨性愈合，愈合时间为11-23周，平均16．6周。无内固定失效、骨折移位及骨坏死发生。1例患者出现伤口感染，1例患者出现伤口不愈合，经治疗后痊愈。根据Letenneur功能评估标准评定疗效：优良11例，可1例，优良率为91．7％。结论拉力螺钉辅加抗滑钢板治疗Hoffa骨折疗效优良、可靠。选择正确的手术入路、解剖复位及坚强固定是治疗成功的关键。Objective To investigate the clinical efficacy of internal fixation with lag screws plus an auxiliary sliding plate for the treatment of Hoffa fractures. Methods A retrospective analysis was made for 12 patients （14 condyles） with Hoffa fracture who had been treated in our hospital from December 2007 through November 2011. They were 8 males （10 condyles） and 4 females （4 condyles）, with an average age of 36. 2 years （range, from 20 to 61 years）. By the Hoffa classification, 6 cases were medial condylar frac- tures, 4 lateral condylar fractures and 2 bicondylar fractures. By the AO/OTA classification, 10 cases were type 33B32 and 2 type 33B33. By Letenneur＇s classification, 7 condyles were type Ⅰ, one condyle was type Ⅱ and 6 condyles were type Ⅲ. There were 2 open fractures and 10 closed ones. Femoral shaft fracture was complicated in one case, proximal tibia fracture in 3 cases, ankle fracture in one, injury to the knee extensor mechanism in 2, crueiate ligament injury in 4, medial collateral ligament injury in one, and meniscus injury in 3. The time from injury to surgery averaged 3.2 days （from 2 hours to 7 days）. All fractures were reduced under direct vision and fixated with cancellous lag screws plus an additional anti-sliding plate. Results All the patients were followed for 6 to 54 months （average, 20.3 months）. Union was achieved in all patients after an average time of 16.6 weeks （from 11 to 23 weeks）. No implant failure or fracture displacement oc- curred. Incision infection and incision disunion occurred in one case each, but both were cured after intensive care. According to Letenneur＇s functional assessment, 11 cases were excellent or good and one case was fair, giving a good to excellent rate of 91.7%. Conclusions Open reduction and internal fixation with lag screws and an additional anti-sliding plate may result in excellent results for Hoffa fractures. The key to a successful surgery is an appropriate approach, anatomic reduction and rigid fixation.

关 键 词：股骨骨折 骨折固定术 内 骨钉 骨板 

分 类 号：R687.3[医药卫生—骨科学]