浮膝损伤Fraser分型的改良：附28例临床报告

The self-modified Fraser＇s classification for floating knees used in clinic

【摘要】目的设计一种浮膝损伤的改良Fraser分型并探讨其临床意义。方法2006年1月至2009年12月共收治且获得完整随访的28例浮膝损伤患者，男2l例，女7例；年龄18-87岁，平均43岁。将浮膝损伤按改良Fraser分型分为3型：I型，关节外骨折；Ⅱ副，骨折累及股骨远端和（或）胫骨近端关节而；Ⅲ型，合并髌骨骨折。Ⅱ型和Ⅲ型又各自分为2个亚型：ⅡA型，关节内简单骨折；ⅡB型．关节内复杂骨折；ⅢA型，髌骨简单骨折；ⅢB型，髌骨粉碎性骨折。本组I型11例，ⅡA型2例，ⅡB型8例，ⅢA型2例，ⅢB型5例。受伤至内固定于术时问平均为9d（0-17d）。l例患者在受伤当天接受手术治疗；12例患者采用外固定支架临时固定，15例患者采用石膏托或牵引固定，最终行钢板或髓内钉固定。，未次随访时根据Kalstrom和Olerud标准评定疗效。结果28例患者术后获平均29个月（12-60个月）随访。末次随访时根据Kalstrom和Olerud标准评定疗效：优7例，良13例，可5例，差3例，优良率为71．4％。11例I型患昔：优6例，良4例，可1例；2例ⅡA型患者均为良；8例HB型患背：优I例，良4例，可2例，差1例；2例ⅢA型患者：良1例，可1例；5例ⅢB型患者：良2例，可l例，差2例。7例患者术后出现并发症：感染3例，膝关节不稳2例，膝关节僵硬2例。结论改良Fraser分型有助于外科医牛比较浮膝损伤的治疗结果并判断预后。根据改良Fraser分型，ⅡA型与I型损伤患者效果相当，ⅡB型和Ⅲ型损伤患者预后较差。

Objective To report a self-modified Fraser＇s classification fror floating knees and its clinical significance. Methods Between January 2006 and December 2009, 28 patients floating knee were treated and followed fully by our department. They were 21 nleu and 7 women. Their mean age was 43 years （range, 18 to 87 years） . Our self-nlodified Fraser＇s classifieation divides floating knees into 3 types： type I, extra-articular fractures; type li, fractures involving the articular facet of distal femur and/or proxi- mal tibia; type Ⅲ, fractures combined with patellar fracture. There were 2 sub-types in both type li and type Ⅲ： type liA, simple intra-articular fractures; type liB, eomplex intra-articular fractures; type IliA, simple patellar fractures; type Ⅲ B. eomminuted patellar fractures. In this series, 11 cases were type l, 2 type liA, 8 type ⅡB, 2 type ⅢA and 5 type Ⅲ B. The time from injury＂ to definitive fixation averaged 9 days （range, 0 to 17 days） . Twelve cases used an external fixator and 15 used a plaster slab or traction for temporary sta- bilization; definitive fixation was performed using either nailing or plating. Functional outcomes were assessed according to criteria by Kalstrom and Olerud. Results The patients were follnwed for a mean of 29 months （range, 12 to 60 months） . By the Kalstrmn ＆ Olerud criteria, the funetional outcomes at the last follow-up were excellent in 7 patients, good in 13, fair in 5 and poor in 3, giving an excellent to good rate of 71.4%. Of the 11 cases of type I, 6 were excellent, 4 good and one fair. The 2 type liA cases were all good. Of the 8 cases of type liB, one was excellent, 4 were good, 2 fair and one poor. The 2 type mA cases got one good and one fair result. Of the 5 cases of type m B, 2 were good, one was fair and 2 were poor. Infection occurred in 3 cases, knee instability and knee stiffness were found in 2 cases each. Conclusion Our self-modified Fraser＇s classification may provide a more reliable basis for a surgeon to compare treatment results and assess prognosis. According to the modified classification, type ⅡA and type Ⅰ injuries can have comparable outcomes while Type ⅡB and type Ⅲ injuries may have poorer prognosis.