膝关节内骨折软骨下骨与软骨粉碎性损伤结构修复及疗效分析

Clinical Outcomes of Subchondral Bones and Cartilage Crush Injuries in Knee Fractures

目的探讨膝关节内骨折软骨下骨与软骨联合粉碎性损伤的关节面解剖结构修复方法及疗效。方法 2008年4月至2009年9月手术治疗关节面严重碎裂的膝关节内粉碎性骨折患者96例。碎裂的软骨下骨连同软骨应用镶嵌挤压、关节内折块间加压,辅以细克氏针固定修复关节面性解剖结构,术后外固定架或石膏外固定4～8周。结果 96例患者X线片示骨折全部愈合,关节面平整,无明显塌陷及骨性游离体形成。采用Rasmussen评价标准,优72例,良20例,可3例,差1例。结论应用镶嵌挤压、关节内折块间加压及辅以细克氏针固定骨软骨折块方法,可修复膝关节软骨下骨与软骨粉碎性联合损伤面性解剖结构,膝关节功能恢复满意。

Objective To examine the repair and outcomes of joint surface anatomy in intra-knee fractured subchondral bones and cartilage crush injuries.Methods From April 2008 to September 2009,intra-knee crush fracture patients（n=96）complicated with severely injured carticular surfaces received surgical intervention.The crushed subchondral bones and cartilages were embedded and compressed,in addition to be fixed with fine Kirschner wire.The additional external fixator or cast was used for 4-8 weeks postoperative.Results X-ray films showed healed fractures in all the treated patients,manifesting as flat carticular surfaces and free of any collapse or mobile body.As evaluated by Rasmussen＇s method,excellent results were seen in 72 patients,good in 20 patients,fair in 3 patients,and poor in one patient.Conclusion The use of embedded compression and auxiliary fine Kirschner wire was effective in the repair of carticular surfaces in intra-knee subchondral bones and cartilages combined fractures,achieving a satisfactory joint function.