Hoffa骨折的临床特征和手术治疗

Clinical features and surgical treatment of Hoffa fractures

目的 总结Hoffa骨折的临床特征,探讨Hoffa骨折的手术治疗方法及其疗效. 方法 选择2007年1月-2011年12月收治的18例Hoffa骨折患者,均为男性；年龄18 ～58岁,平均36.8岁.新鲜骨折17例,陈旧性骨折不愈合1例.外侧髁骨折8例,内侧髁骨折10例.骨折按Letenneur分型：Ⅰ型9例,Ⅱ型3例,Ⅲ型6例.所有患者均选择相应的手术入路行切开复位螺钉内固定术,其中13例采用2～3枚直径4.5 mm的空心螺钉自前向后固定,5例采用2～4枚直径2.4,3.0或4.0 mm的无头加压螺钉自后向前固定. 结果 18例患者中3例在初诊时发生漏诊,漏诊率为17％ （3/18）,均行CT检查明确诊断.14例患者获得随访平均24个月（12～ 60个月）；均获得骨性愈合,愈合时间为8 ～ 24周,平均为12周.术后无感染、深静脉血栓、复位丢失、内固定失效等并发症.疗效按Letenneur评估系统评价：优良11例,可2例,差1例. 结论 早期切开解剖复位、坚强内固定是治疗Hoffa骨折成功的关键.手术入路和螺钉的种类、直径和方向应根据Hoffa骨折类型、骨块大小和是否粉碎进行选择.

Objective To summarize the clinical features of Hoffa fractures and to investigate the surgical strategies and curative effect. Methods The study enrolled 18 patients with Hoffa fractures trea- ted from January 2007 to December 2011. All the patients were male, at a mean age of 36.8 years （ range, 18-58 years）. There were 17 patients with fresh fractures and 1 with old fracture nonunion. Lateral condylar fractures occurred in 8 patients and medial condylar fractures in 10. According to Letenneur＇ s classifica- tion, 9 fractures were type 1,3 type ]I and 6 type HI. Open reduction and internal fixation was performed, including 13 patients being fixed with 2-3 cannulated screws of 4.5 mm via anterior approach and 5 patients with 2-4 headless compression screws of 2.4, 3.0 or 4.0 mm via posterior approach. Results Three pa- tients were misdiagnosed at the first visit with a missed diagnosis rate of 17% （3/18）, but were later con- firmed in CT scanning. Fourteen patients were followed up for a mean period of 24 months （ range, 12-60 mouths） , with bony healing in average 12 weeks （range, 8-24 weeks）. There were no complications of in- fections, deep vein thrombus, reduction loss, or implant failure. According to Letenneur＇ s assessment sys- tem, the outcome was excellent or good in 11 patients, fair in 2, and poor in 1. Conclusions Early ana- tomical open reduction and rigid internal fixation are key to successful treatment. Surgical approaches and types, diameters as well as entry directions of screws should be determined with reference to the fracture type, size of fracture fragment and presence or absence of comminution.