空心拉力螺钉结合侧方支持钢板治疗LetenneurⅠ型及Ⅲ型Hoffa骨折  

CANNULATED LAG SCREW COMBINED WITH LATERAL SUPPORTING PLATE FOR TREATMENT OF Hoffa FRACTURE OF Letenneur TYPE Ⅰ AND TYPE Ⅲ

作　　者：林涛[1] 杨述华[1] 肖宝钧[1] 傅德皓[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中国修复重建外科杂志》2013年第9期1050-1053,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用空心拉力螺钉结合侧方支持钢板治疗LetenneurⅠ、Ⅲ型Hoffa骨折的疗效。方法 2004年5月-2011年4月,收治11例闭合性LetenneurⅠ、Ⅲ型Hoffa骨折。其中男6例,女5例;年龄25～47岁,平均36岁。致伤原因:交通事故伤8例,跌落伤2例,其他伤1例。左侧7例,右侧4例。按Letenneur等的股骨髁冠状面骨折分型:Ⅰ型7例,其中外髁骨折6例、内髁骨折1例;Ⅲ型4例,其中外髁骨折3例、内髁骨折1例。新鲜骨折9例,陈旧性骨折2例。采用膝关节前内侧或前外侧切口,前后方向植入2枚直径6.5 mm空心拉力螺钉并结合侧方支持钢板固定。结果术后切口均Ⅰ期愈合,无早期并发症发生。11例均获随访,随访时间12～26个月,平均15个月。X线片示骨折均达骨性愈合,愈合时间10～18周,平均15周。术后无内固定物松动及断裂;均于术后9～15个月,平均12个月取出内固定物。末次随访时按Letenneur等的Hoffa骨折术后功能恢复评估标准评定,获优7例,良3例,差1例。结论空心拉力螺钉结合侧方支持钢板治疗LetenneurⅠ、Ⅲ型Hoffa骨折内固定可靠,骨折愈合率高;前外侧或前内侧入路是首选入路,尤其适合于合并胫骨平台或髌骨骨折的患者。Objective To investigate the effectiveness of cannulated lag screws combined with lateral supporting plates in the treatment of Hoffa fracture of Letenneur type I and type III. Methods Between May 2004 and April 2011, 11 patients with Hoffa fracture of Letenneur type I and type III were treated, including 6 males and 5 females with an average age of 36 years （range, 25-47 years）. Factures were caused by traffic accident in 8 cases, by falling in 2 cases, and by the other in 1 case. Fracture involved the left knee in 7 patients and the right knee in 4 patients. According Letenneur＇s classification criteria, there were 7 type I fractures （6 lateral condyle fractures and 1 medial condyle fracture） and 4 type III fractures （3 lateral condyle fractures and 1 medial condyle fracture）. Of 11 fractures, 9 were fresh fractures and 2 were old fractures. Two 6.5 mm cannulated lag screws combined with lateral supporting plates were used to fix fractures by anterolateral or anteromedial incision. Results All incisions achieved primary healing with no early complication. All patients were followed up 12-26 months （mean, 15 months）. X-ray films showed bone healing with an average healing time of 15 weeks （range, 10-18 weeks）. No loosening or breaking of internal fixator was observed; the removal time of internal fixation was 9-15 months （mean, 12 months）. Accoding to Letenneur＇s functional assessment system, the results were excellent in 7 cases, good in 3 cases, and poor in 1 case at last follow-up. Conclusion Cannulated lag screws combined with lateral supporting plates fixation is effective in treatment of Hoffa fracture of Letenneur type I and type III with a high union rate; anterolateral or anteromedial approach is the first choice for Hoffa fracture of type I and type III, especially for complicating by tibial plateau fracture or patella fracture.

关 键 词：HOFFA骨折 切开复位 空心拉力螺钉 侧方支持钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]