两种术式治疗股骨远端单髁或双髁冠状面骨折的疗效对比

The Comparison of Clinical Effects of Two Different Surgical Procedures for the Treatment of Hoffa Fractures

目的比较两种手术方法治疗Hoffa骨折的临床疗效。方法选择临高县中医院、海南医学院第一附属医院骨科2010年2月至2017年12月收治的Hoffa骨折患者共60例,根据手术中固定方法分为研究组和对照组,每组30例。对照组术中仅采用拉力螺钉固定治疗,研究组术中采用侧方支撑钢板辅助拉力螺钉治疗。比较两组患者术中出血量、骨折愈合时间;通过问卷调查方式,于术后随访3个月进行随访,对患者膝关节进行术后Letenneur评分;比较两组患者术后远期并发症发生率。结果研究组患者术中出血量明显高于对照组(138. 5±14. 7) ml vs.(105. 5±15. 6) ml,差异有统计学意义(P <0. 01)。两组骨折愈合时间无明显统计学差异,分别为(12. 5±3. 4)周vs.(11. 8±3. 7)周(P>0. 05)。两组患者术后膝关节评分的优良率无明显统计学差异(76. 7%vs. 70%)(P> 0. 05)。两组远期并发症主要有关节僵硬、骨折延迟愈合、创伤性关节炎,发生率无明显统计学差异(16. 7%vs. 30%)(P>0. 05)。结论侧方支撑钢板辅助拉力螺钉或仅采用拉力螺钉固定治疗Hoffa骨折疗效明显,后者具有术中出血量少的优点。

Objective To compare the effects of two different surgical procedures for the treatment of Hoffa fractures. Methods A total of 60 patients with Hoffa fractures admitted to the Orthopedics Department of Lingao Traditional Chinese Medicine Hospital and the First Affiliated Hospital of Hainan Medical College from February 2010 to February 2017 were selected, and were divided into the study group and the control group according to the fixation methods during operation, with 30 in each. In the control group, only the tension screws were used for fixation. While in the study group, the lateral supporting steel plate was used to assist the tension screws. Intraoperative blood loss and fracture healing time were compared between the two groups. The patients were followed up for 3 months after operation. Questionnaire survey of postoperative Letenneur score was conducted to evaluate the knee joint function. And the incidence of long-term postoperative complications was compared between the two groups. Results Intraoperative blood loss of the study group was significantly higher than the control group, which was （138.5±14.7）ml vs.（105.5±15.6）ml, and the difference was statistically significant（ P 〈0.01）. There was no significant difference in fracture healing time between the two groups （ P 〉0.05）, which was （12.5±3.4） weeks vs. （ 11.8±3.7） weeks. There was no statistically significant difference in postoperative Letenneur score（76.7% vs. 70%） between the two groups （ P 〉0.05）. The long-term complications of the two groups were mainly related to arthrosis, delayed fracture healing, and traumatic arthritis, and there was no difference between the two groups （16.7% vs. 30%）（ P 〉0.05）. Conclusions The curative effect of the treatment of Hoffa fracture with side supporting steel plate or only using tension screws is obvious, and the latter has the advantage of low intraoperative blood loss.