扩大Carlson入路治疗股骨外侧髁Hoffa骨折疗效分析  

Effectiveness of extended Carlson approach in treatment of lateral femoral condylar Hoffa fractures

作　　者：王海[1] 叶君健[1] 郑力峰[1] 陈尧清 吴贵[1] 谢昀[1] WANG Hai;YE Junjian;ZHENG Lifeng;CHEN Yaoqing;WU Gui;XIE Yun(Department of Orthopedic Trauma&Ankle Surgery,Fujian Trauma Medical Center,First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian,350004,P.R.China)

机构地区：[1]福建医科大学附属第一医院创伤骨科、足踝外科福建省创伤医学中心,福州350004

出　　处：《中国修复重建外科杂志》2021年第4期439-444,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：福建医科大学启航基金项目(2017XQ1082)。

摘　　要：目的探讨采用扩大Carlson入路治疗股骨外侧髁Hoffa骨折的临床疗效。方法回顾分析2012年9月—2019年1月收治的17例股骨外侧髁Hoffa骨折患者临床资料。男10例,女7例;年龄32~68岁,平均43岁。致伤原因:交通事故伤9例,高处坠落伤6例,其他伤2例。根据Letenneur分型:Ⅰ型8例,Ⅱ型6例,Ⅲ型3例。受伤至手术时间3~32 d,平均7 d。均采用扩大Carlson入路治疗,LetenneurⅠ、Ⅲ型患者采用后前方向螺钉联合后侧抗滑移钢板固定,Ⅱ型患者采用单纯后前方向螺钉固定。术后复查膝关节正侧位X线片、膝关节CT及三维重建,评估骨折愈合及内固定物在位情况;采用Letenneur等的Hoffa骨折功能评估标准评价膝关节功能。结果患者术后均获随访,随访时间13~28个月,平均15个月。术后切口均Ⅰ期愈合,无骨折再移位、骨折不愈合、内固定物断裂、腓总神经损伤等并发症发生。骨折愈合时间16~32周,平均18周。末次随访时,按Letenneur等标准评价膝关节功能,获优12例、良5例,优良率100%。结论采用扩大Carlson入路治疗股骨外侧髁Hoffa骨折,具有显露清楚、便于复位与固定、骨折愈合率高、并发症少、膝关节功能恢复良好的优点。Objective To investigate the effectiveness of the extended Carlson approach in the treatment of lateral femoral condylar Hoffa fractures. Methods The clinical data of 17 patients with lateral femoral condyle Hoffa fractures between September 2012 and January 2019 were retrospectively analyzed. There were 10 males and 7 females,with a mean age of 43 years(range, 32-68 years). Fractures were caused by traffic accident in 9 cases, by falling from height in 6 cases, and by the other mechanism in 2 cases. According to the Letenneur’s classification, there were 8 cases of typeⅠ, 6 cases of type Ⅱ, and 3 cases of type Ⅲ. The mean time from injury to operation was 7 days(range, 3-32 days).All patients were treated with extended Carlson approach. Patients with Letenneur types Ⅰ and Ⅲ were fixed by a posterior antigliding plate combined with headless compression screws from anteroposterior direction, and patients with Letenneur typeⅡ were fixed by headless compression screws from anteroposterior direction. The anteroposterior and lateral X-ray films, CT and three-dimensional reconstruction of the knee joint were taken after operation to assess fracture healing and position of the internal fixators. The knee function was evaluated according to Letenneur’s functional assessment system. Results All patients were followed up 13-28 months(mean, 15 months). All the incisions healed by first intention, and no complication such as fracture redisplacement, fracture nonunion, internal fixator fracture, and common peroneal nerve injury occurred. The mean time of fracture healing was 18 weeks(range, 16-32 weeks). At last follow-up, according to Letenneur’s functional assessment system, the knee function was excellent in 12 cases and good in 5 cases, with an excellent and good rate of 100%. Conclusion The extended Carlson approach for the treatment of lateral femoral condylar Hoffa fractures has the advantages of clear exposure, easy reduction and fixation,high fracture healing rate, few complications, and good recove

关 键 词：HOFFA骨折 股骨外侧髁 手术入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]