空心钉联合跟骨锁定钢板内固定治疗粉碎性LetenneurⅠ、Ⅲ型Hoffa骨折疗效观察  

Efficacy of hollow screws combined with calcaneal locking plate in treating comminuted Letenneur typeⅠandⅢHoffa fractures

作　　者：王飞 兰俊[1] 夏海波[1] 牛晓辉 梁伟[1] WANG Fei;LAN Jun;XIA Haibo;NIU Xiaohui;LIANG Wei(Department of Orthopaedics,People’s Hospital of Lishui City,Lishui,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院骨科,浙江323000

出　　处：《中国骨与关节损伤杂志》2024年第10期1024-1027,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察空心钉联合跟骨锁定钢板内固定治疗粉碎性LetenneurⅠ、Ⅲ型Hoffa骨折的临床疗效。方法回顾性分析自2017-10—2022-06诊治的14例粉碎性LetenneurⅠ、Ⅲ型Hoffa骨折,骨折复位后于屈膝状态下由后向前置入1~3枚导针,导针指向尽可能垂直矢状位上的主骨折线,然后置入合适长度的空心钉。根据骨折类型及骨折线分布选取跟骨锁定钢板,将钢板预弯、修剪后放到合适的位置,需要注意侧副韧带止点的位置,避免对其造成激惹,同时尽可能置入3或4枚螺钉固定至远端骨折块上以增强把持力。结果14例均获得随访,随访时间为10~28个月,平均14.9个月。随访期间未出现感染、下肢深静脉血栓形成、内固定松动断裂、骨折不愈合、膝关节僵硬及股骨髁缺血性坏死等并发症,2例出现创伤性关节炎。术后3个月膝关节活动度为114°~120°,平均117.2°;术后6个月膝关节活动度为119°~125°,平均121.4°。骨折愈合时间为12~17周,平均14.7周。末次随访时采用膝关节KSS评分标准评定疗效:优11例,良2例,可1例。结论采用空心钉联合跟骨锁定钢板内固定治疗粉碎性LetenneurⅠ、Ⅲ型Hoffa骨折的疗效满意,能够对粉碎骨块进行有效固定,有利于骨折愈合与膝关节功能恢复。Objective To observe the clinical efficacy of hollow screws combined with calcaneal locking plate in treating com⁃minuted Letenneur typeⅠandⅢHoffa fractures.Methods A retrospective analysis was performed on 14 cases of Letenneur typeⅠandⅢcomminuted Hoffa fractures treated from October 2017 to June 2022.After fracture reduction,one to three guide pins were placed from posterior to anterior under knee flexion.The guide pins were directed to the main fracture line on the ver⁃tical sagittal plane as possible,and then hollow screws of appropriate length were inserted.According to fracture type and calca⁃neal fracture line,locking plate was selected,the plate was positioned on the right place after bending,trimming,attention should be paid to the position of the lateral collateral ligament check point,to avoid its irritability,at the same time 3 or 4 screws as much as possible were inserted into distal fracture block to increase holding force.Results All patients were followed up for 10-28 months(mean,14.9 months).No complications such as infection,lower extremity deep vein thrombosis,internal fixation loosening and breakage,nonunion fracture,knee joint stiffness or avascular necrosis of the femoral condyle occurred,2 cases had traumatic arthritis during the follow-up period.The range of motion of knee joint was 114°-120°(mean,117.2°)at 3 months after operation.The range of motion of knee joint was 119°-125°(mean,121.4°)at 6 months after operation.Fracture healing time was 12-17 weeks,an average of 14.7 weeks.The curative effectat the last follow-up evaluation with knee KSS score stan⁃dard:excellent in 11 cases,good in 2 cases,fair in 1 case.Conclusion The clinical outcomes are satisfactory for the treatment of comminuted Letenneur typeⅠandⅢHoffa fractures with hollow screws combined with calcaneal locking plate.It can effec⁃tively fix the comminuted bone fragments,which is beneficial to fracture healing and knee joint function recovery.

关 键 词：HOFFA骨折 粉碎性骨折 跟骨锁定钢板 空心钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]