空心拉力螺钉结合跟骨锁定接骨板治疗LetenneurⅢ型Hoffa骨折的疗效

Effect of hollow lag screw combined with calcaneal locking plate in the treatment of Letenneur type III Hoffa fracture

目的比较空心拉力螺钉结合跟骨锁定接骨板与空心拉力螺钉治疗LetenneurⅢ型Hoffa骨折的临床疗效。方法采用回顾性队列研究分析2010年1月至2020年6月解放军中部战区总医院收治的41例LetenneurⅢ型Hoffa骨折患者临床资料,其中男22例,女19例;年龄28~78岁[(51.9±1.9)岁]。18例采用空心拉力螺钉结合跟骨锁定接骨板固定治疗(钢板螺钉组),23例采用空心拉力螺钉固定治疗(螺钉组)。比较两组术后卧床时间、住院时间、骨折愈合时间。比较两组术后3,6个月膝关节活动度(ROM)、膝关节协会评分(KSS)及远期并发症发生率。结果患者均获随访10~24个月[(14.5±2.1)个月]。钢板螺钉组术后卧床时间为(37.6±2.4)d,少于螺钉组的(45.2±1.6)d(P<0.05)。钢板螺钉组和螺钉组住院时间分别为(16.7±3.7)d和(15.8±3.7)d,骨折愈合时间分别为(12.2±0.9)周和(12.7±0.7)周(P均>0.05)。术后3,6个月钢板螺钉组膝关节ROM分别为(119.9±2.9)°和(125.4±4.5)°,优于螺钉组的(116.6±4.5)°和(122.1±3.9)°(P均<0.05)。术后3,6个月钢板螺钉组KSS分别为(83.4±3.1)分和(86.2±2.5)分,优于螺钉组的(79.5±2.1)分和(82.2±2.2)分(P均<0.05)。随术后时间推移,两组膝关节ROM和KSS显著增加(P均<0.01)。钢板螺钉组远期并发症包括骨折延迟愈合1例,创伤性关节炎1例,关节僵硬1例,并发症发生率为17%(3/18);螺钉组远期并发症包括内固定失效1例,骨折延迟愈合2例,骨不连1例,创伤性关节炎2例,关节僵硬2例,并发症发生率为35%(8/23)。两组远期并发症发生率差异无统计学意义(P>0.05)。结论与单纯空心拉力螺钉固定相比,空心拉力螺钉结合跟骨锁定接骨板治疗LetenneurⅢ型Hoffa骨折具有术后卧床时间短、早期可行功能锻炼、膝关节ROM改善及功能恢复好等优点。

Objective To compare the clinical effect of cannulated lag screw combined with calcaneal locking plate versus cannulated lag screw in the treatment of Letenneur type III Hoffa fracture.Methods A retrospective cohort study was performed on clinical data of 41 patients with Letenneur type III Hoffa fracture admitted to General Hospital of Central Theater Command of PLA from January 2010 to June 2020.There were 22 males and 19 females,aged 28-78 years[(51.9±1.9)years].A total of 18 patients were treated with cannulated lag screw combined with calcaneal locking plate(plate-screw group)and 23 patients were treated with cannulated lag screw(screw group).The bed rest time,hospital time and bone healing time were compared between the two groups.Range of motion(ROM)of the knee at 3 and 6 months postoperatively,knee society score(KSS)at 3 and 6 months postoperatively and incidence of long-term complications were compared between the two groups.Results All patients were followed up for 10-24 months[(14.5±2.1)months].The bed rest time was(37.6±2.4)days in plate-screw group,lower than(45.2±1.6)days in screw group(P<0.05).The hospital time was(16.7±3.7)days in plate-screw group,and(15.8±3.7)days in screw group(P>0.05).The bone healing time was(12.2±0.9)weeks in plate-screw group and(12.7±0.7)weeks in screw group(P>0.05).ROM of the knee at 3 and 6 months after operation was(119.9±2.9)°and(125.4±4.5)°in plate-screw group,greater than(116.6±4.5)°and(122.1±3.9)°in screw group(both P<0.05).KSS at 3 and 6 months after operation was(83.4±3.1)points and(86.2±2.5)points in plate-screw group,greater than(79.5±2.1)points and(82.2±2.2)points in screw group(both P<0.05).ROM of the knee and KSS in two groups increased significantly over time(both P<0.01).The long-term complications in plate-screw group included delayed fracture healing in 1 patient,traumatic arthritis in 1 and stiff joint in 1,showing the complication rate of 17%(3/18).The long-terem complications in screw group included internal fixation failure in 1 patient,delayed fracture healing in 2,nonunion in 1,traumatic arthritis in 2 and stiff joint in 2,showing the complication rate of 35%(8/23).The two groups had no significant difference in the complication rate(P>0.05).Conclusion For Letenneur type III Hoffa fracture,cannulated lag screw fixation combined with calcaneal locking plate is superior to seperate cannulated lag screw fixation in aspects of short bed-term bed rest,early functional exercise,improved ROM and good function recovery.