可吸收钉与股骨内髁解剖钢板修复内侧髁Hoffa骨折:钢板贴附较好固定牢靠

Absorbable screws and anatomical plate of medial femoral condyle for treatment of medial condyle Hoffa fractures: good steel plate attachment and firm fixation

背景:股骨内侧髁Hoffa骨折常伴有关节面粉碎,如治疗不当可出现骨折不愈合、膝关节功能障碍等并发症。单独使用螺钉固定很难实现粉碎骨折块整体化,固定强度欠佳;另外普通钢板用于内侧髁Hoffa骨折时往往需要术中进行不断塑形,且对螺钉固定方向有一定限制,影响复位后骨折块的稳定性。目的:探讨股骨内侧髁Hoffa骨折损伤特点并分析应用可吸收钉结合股骨內髁解剖钢板修复此类骨折的效果。方法:回顾性分析2010年5月至2013年6月天津医院创伤骨科采用可吸收钉结合股骨远端内侧解剖钢板修复股骨内侧髁Hoffa骨折12例患者的病例资料,男8例,女4例;年龄21-67岁,平均42岁。治疗前均行膝关节正、侧位X射线片及CT、MRI检查。12例患者均行切开复位内固定治疗,术中采用可吸收钉结合解剖钢板内固定骨折,治疗后随访观察患者骨折愈合及膝关节功能恢复情况。结果与结论:所有患者均获得随访,随访时间16-48个月。骨折均愈合,无内固定松动及骨折再移位等并发症发生,患者膝关节屈曲范围为110°-135°,按膝关节Letenneur评分标准评定疗效,优9例,良2例,可1例,优良率为92%。可见可吸收钉固定可实现关节面粉碎骨块的整体化,再结合股骨內髁解剖钢板治疗内侧髁Hoffa骨折,可进一步坚强固定骨折,操作方便,钢板贴附较好,具有固定牢靠、并发症少、可早期进行功能锻炼、修复效果好等优点,可为临床修复此类骨折提供参考。

BACKGROUND：Medial condyle Hoffa fractures is often accompanied by joint surface grinding, so improper therapy would induce disunion of fracture or knee dysfunction. Screw fixation alone is difficult to realize entirety of comminuted fracture block. Fixation intensity is poor. In addition, common steel plate for medial condyle Hoffa fractures requires constant shaping during surgery. Moreover, it limits the direction of the screw and impacts the stability of fracture fragments after resetting. OBJECTIVE：To explore the characteristics of medial condyle Hoffa fractures, and analyze the effects of absorbable screws combined with femoral condyle anatomical plate in the treatment of above fracture. METHODS：Data of 12 patients with medial condyle Hoffa fractures treated with absorbable screws combined with distal medial femoral anatomic plates in the Department of Traumatic Orthopedics of Tianjin Hospital in China from May 2010 to June 2013 were retrospectively analyzed. There were 8 males and 4 females at the age of 21-67 years, averagely 42 years. Before treatment, al patients were subjected to knee anterioposterior, lateral X-ray films and CT, and MRI examination. 12 patients received open reduction and internal fixation, intraoperative＆nbsp;fracture with absorbable screw combined with anatomic plate fixation. After treatment, fracture healing and the knee joint function recovery were observed during fol ow-up. RESULTS AND CONCLUSION：Al patients were fol owed up for 16-48 months. Fractures were healed. No loosening or fracture re-displacement occurred. Flexion range of knee joint was from 110° to 135°. According to Leteneur’s functional assessment system, there were excel ent in 9 cases, good in 2 cases, fair in 1 case with the excel ent and good rate of 92%. The absorbable screw fixation can realize the entirety of articular surface of crushed bone. The absorbable screw fixation combined with anatomic plate is effective in treatment of medial condyle Hoffa fracture, which further strengthened fixation. Its operation is convenient. Steel plate attachment is good, has some advantages, such as firm fixation, less complications, early functional exercises, and good repair effects. Thus, it can provide reference for the repair of above fractures.