Hoffa骨折的治疗

Treatment of Hoffa fractures

目的总结Hoffa骨折的临床特点，探讨其治疗方法及临床疗效。方法对2002年1月至2009年4月收治的20例24髁Hoffa骨折患者资料进行回顾性分析，男14例18髁，女6例6髁；年龄20～70岁，平均43．3岁。股骨内髁骨折15髁，外髁骨折9髁；其中单侧双髁骨折2例，单侧双髁并对侧单髁骨折1例；新鲜骨折20髁，陈旧性骨折内固定失效4髁。骨折按Letenneur分型：I型6髁，Ⅱ型4髁，Ⅲ型14髁。15髁使用从前向后方向2～4枚直径3．5或6．5mm松质骨螺钉或空心螺钉固定，8髁使用从后向前方向螺钉固定，1髁开放性骨折采用2枚3．0mm克氏针固定。5髁联合使用侧方支持钢板结合螺钉固定，3髁联合使用后方抗滑移钢板结合螺钉固定。结果20例患者术后获平均14．4个月（6～84个月）随访。所有患者骨折均获骨性愈合，愈合时间为12—44周，平均18．6周，无骨折不愈合、感染、内固定松动及股骨髁缺血性坏死等并发症发生。参照Letenneur等的Hoffa骨折术后功能评估标准评定疗效：优16髁，良6髁，差2髁，优良率为91．7％。结论Hoffa骨折临床少见，螺钉固定是Hoffa骨折手术固定方法的金标准，螺钉固定方向、直径及手术切口的选择应视骨折类型和骨折块大小而定。对于不稳定Hoffa骨折，在螺钉固定的基础上应考虑联合应用侧方支持钢板或后方抗滑移钢板固定。

Objective To investigate clinical characteristics and treatment of Hoffa fractures. Methods Twenty patients with Hoffa fracture （24 condyles） were treated from January 2002 to April 2009. They were 14 men （18 condyles） and 6 women （6 condyles）, aged from 20 to 70 years （average, 43.3 years）. There were 15 fractures of medial femoral condyle and 9 ones of lateral femoral condyle. Two rare cases were fractures of unilateral bi-condyles and one rare case fractures of unilateral bi-condyles plus contralateral single condyle. Four fractured condyles were old due to implant failure and 20 were fresh. According to the modified Letenneur＇s classification, there were 6 condyles of type I, 4 condyles of type 11 and 14 condyles of type m. Fifteen condyles were fixed anteroposteriorly with 2 to 4 cancellous or canulated screws, 8 condyles were fixed posteroanteriorly with 2 to 4 screws, and one condyle was fixed with K wires. Five condyles were fixed with screws plus lateral supporting plates, and 3 condyles with screws plus posterior anti-sliding plates. Results All the patients were followed up for an average of 14. 4 months （6 to 84 months） . All the 24 condyles obtained bony union after an average of 18.6 weeks （from 12 to 44 weeks）. There was no infection, implant failure, nonunion or bone necrosis. According to Letenneur＇s functional assessment system, 16 condyles were excellent, 6 good and 2 poor, with a good-to-excellent rate of 91.7%. Conclusions All Hoffa fractures should be treated with screws. Screw diameter, fixation direction and surgical incision should depend on facture type and size of fracture block. Unstable Hoffa fractures should be treated with screws combined with lateral supporting plates or posterior anti-sliding plates.