合并伸膝装置损伤的Hoffa骨折的治疗

Treatment of Hoffa facture associated with extensor mechanism injury

[目的]研究合并伸膝装置损伤的Hoffa骨折的伤情特点和治疗方法.[方法]本院近6年治疗4例Hoffa骨折伴伸膝装置损伤患者均系多发伤,伴同侧肢体骨折及不同程度的髌旁支持带和关节囊的撕裂伤.伸膝装置损伤部位包括1例髌韧带远端撕脱,2例髌韧带近端撕脱,1例股四头肌腱撕裂.单侧双髁骨折3例,均不伴有交叉韧带损伤.单侧单髁骨折1例,同时合并前、后交叉韧带和内侧副韧带损伤.3例开放性骨折行急诊清创、骨折复位拉力螺钉内固定,伸膝装置修复、减张钢丝固定.1例闭合性骨折伤后1周全身情况稳定后再行手术.合并同一肢体骨折者同时行手术复位内固定.术后石膏伸直位制动4～6周开始功能锻炼.[结果]4例患者伤口均Ⅰ期愈合,未出现感染及皮肤坏死.通过6个月～3年的随访,4例7髁均达骨性愈合,愈合时间为6～12周.根据Letenneur等的Hoffa骨折术后功能评估标准综合评估：优良1例,可3例.[结论]合并伸膝装置损伤的Hoffa骨折常伴有合并伤.开放性损伤宜急诊手术,一期固定骨折及修复伸膝装置.减张钢丝固定可增强伸膝装置的稳定,便于术后早期功能锻炼.

[ Objective] To investigate the injury characteristics and treatment of the Hoffa facture associated with extensor mechanism injury. [ Method ] Four patients with Hoffa facture associated with extensor mechanism injury treated in author＇s hospital in recent 6 years were enrolled in this study. All the patients were multiple - injured, and associated with the ipsilateral limb fracture and retinacular and capsule laceration. The site of the extensor mechanism injury included 1 distal patellar tendon disruption ,2 proximal patellar tendon disruption ,and 1 distal quadriceps tendon disruption. No cruciate ligament injury was found in 3 ipsilateral bicondylar fractures. One unicondylar fracture was associated with anterior and posterior cruciate ligament and medial collateral ligament injury simultaneously. Emergency operation was performed along with the debridement in the three open fractures. In another patient with closed fracture, operation was performed one week after injury. Fractures were reduced and fixed with lag screws. Extensor apparatus were repaired and strengthened with a tension band wire through both patella and tibia. Ipsilateral limb fractures were reduced and internal fixed with hardware simultaneously. The knees were immobilized in extension with cast after operation, and flexion exercise was commenced four to six weeks later. [ Result] Four patients wounds reached the first rate healing. There was no infection and necrosis of skin. All patients were followed - up for six months to three years. All 7 condyles of the 4 patients reached bone union. Healing time was about six to twelve weeks. According to Letenneur＇ s functional assessment system, excellent and good results were in 1 cases, fine in 3 cases. [ Conclusion ] Hoffa facture associated with extensor mechanism injury are usually accompanied with injuries in other part of the body. In open fracture, emergency operation is mandatory, and fracture reduction and internal fixation and extensor apparatus repair should be performed along with debridement. Tension band wire may strengthen the stability of the extensor mechanism and facilitated early mobilization.