Hoffa骨折的诊断和治疗进展

Progress in Diagnosis and Treatment of Hoffa Fracture

Hoffa骨折是股骨远端冠状面骨折的统称,是罕见的关节内骨折。其多发生于两轮交通工具的碰撞事故,最可能的发生机制为在屈膝状态下,股骨髁的后半部受到冠状面的垂直暴力,并同时遭受前后及内外翻应力的冲击。Hoffa骨折极易漏诊,平片通常难以发现所有的Hoffa骨折,常需要CT矢状面及三维重建协助诊断。其手术入路有髌旁入路、股内侧肌下方入路、直接外侧入路和后外侧入路等。对于不同类型的Hoffa骨折,可选择不同入路以及内植物,以求通过最少的组织剥离获得最可靠的骨折固定。但目前有关Hoffa骨折的治疗多为个案报道,缺乏远期并发症及关节功能的随访研究,对手术入路的选择以及各种内植物生物力学性能的对比也有待进一步研究。

Hoffa fracture is the general name of coronal fracture of distal femur,which is a rare intra-articular fracture,mostly occurs in the accidents of the collision of two-wheel vehicles.And the most likely mechanism is that the posterior part of the femoral condyle is subjected to vertical violence on the coronal plane and the impact of anterior and posterior,and varus and valgus stress at the same time under the condition of knee flexion.The diagnosis of Hoffa fracture is easy to be missed,and it is usually difficult to find all Hoffa fractures on a plain film.CT sagittal plane and three-dimensional reconstruction are often needed to assist in the diagnosis.The surgical approaches include parapatellar approach,medial vastus muscle approach,direct lateral approach and posterolateral approach.For different types of Hoffa fractures,different approaches and implants can be chosen to obtain the most reliable fracture fixation through minimal tissue peeling.However,the treatment of Hoffa fracture is mostly reported by individual cases,and there is a lack of follow-up study on long-term complications and joint function.The choice of surgical approach and the comparison of biomechanical properties of various implants need to be further studied.