少见的股骨外侧髁骨折1例报告

Management of A Rare Fracture of Lateral Femoral Condyle:One Case Report

目的报道1例少见的股骨外侧髁骨折,介绍其诊疗经验。方法患者,男性,21岁,因“高处坠落后右膝部疼痛、活动受限1小时”入院,经体查、膝关节正侧位X片、CT及MRI检查诊断为股骨外侧髁骨折。完善术前准备后于伤后第二天在全麻下行股骨外侧髁骨折切开复位内固定术。术中见骨折块位于股骨外侧髁前下方,向后上移位,予以复位骨折块,埋头空心钉垂直加压,抗滑钢板固定。结果手术顺利,术后3 d出院。术后3月门诊随访,已弃拐行走,CT检查提示骨折愈合。膝关节Neer评分为96分,HSS评分为98分,膝关节功能等级为“优”。结论青年股骨远端骨折往往为高能量损伤,术前应仔细查体并完善X线摄片、CT、MRI检查,制定完善的手术方案,术中解剖复位、坚强内固定,术后早期康复锻炼,才能取得满意的临床效果。按现有的股骨远端骨折分类标准不能涵盖此种骨折,故其分类标准有待完善,以帮助骨科医生更好地理解和规范治疗此类骨折。

Objective To report a rare case of lateral femoral condyle fracture.Methods The patient,a 21-year-old male,was admitted to the hospital because of"right knee pain and movement restriction for 1 hour after falling from height".After physical examination,frontal and lateral X-ray,CT and MRI,he was diagnosed as fracture of lateral femoral condyle.After improving the preoperative preparation,the fracture of the lateral femoral condyle was treated with internal fixation under general anesthesia on the second day after injury.The fracture was located at the anterior and lower part of the lateral condyle of the femur.It was displaced backward and upward.It was fixed by countersunk hollow nails and an anti-slide plate.Results The operation was successful and the patient was discharged 3 days after operation.His 3-month follow-up showed that the crutch had been abandoned and his CT imaging showed the fracture had healed.Neer score and HSS score of the knee joint were excellent.Conclusion Young distal femoral fractures are often high-energy injuries.Before operation,it needs careful physical examination and the X-ray,CT and MRI examinations.A complete operation plan,anatomic reduction and strong internal fixation during operation,and early rehabilitation after operation are necessary.Atypical fracture types can be included in existing or future classification systems,which will help to better understand and treat these fractures.