切开复位内固定治疗股骨髁冠状面骨折疗效分析.docVIP

切开复位内固定治疗股骨髁冠状面骨折疗效分析 　　作者：张海波，张世清，赵金廷 作者单位：开封市第一人民医院骨科，河南 475000 　　【摘要】 [目的]探讨切开复位、松质骨拉力螺钉内固定治疗股骨髁冠状面骨折的方法及临床疗效。[方法]1998年5月～2006年6月，通过前外(内)侧或后外(内)侧入路，行切开复位、松质骨拉力螺钉内固定术治疗股骨髁冠状面骨折17例，其中男15例，女2例;年龄19～48岁，平均39.5岁。按Letenneur分型：Ⅰ型7例，Ⅱ型4例，Ⅲ型6例。闭合性骨折14例，开放性骨折3例。采用自体髂骨或同种异体骨植骨共5例。术后均行石膏外固定。受伤至手术时间平均3.6 d(2.5 h～8 d)。[结果]所有患者术后获8～26个月(平均18.2个月)随访，骨折均获骨性愈合，骨折愈合时间平均为3.6个月。膝关节功能参照Letenneur评估标准，优良14例，可3例，无差者。本组无深部感染、内固定松动和骨坏死。[结论]切开复位、松质骨拉力螺钉内固定治疗股骨髁冠状面骨折是一种安全、有效的治疗方法。正确选择手术入路、满意的复位和骨折端坚强稳定的内固定对疗效具有决定作用。 　　【关键词】 Hoffa骨折; 股骨髁; 骨折内固定术; 切开复位 　　Treatment effect of the coronal fractures of the femoral condyle with open reduction and internal fixation∥ZHANG Hai-bo,ZHANG Shi-qing,ZHAO Jin-ting.Department of Orthopedics,the First Peoples Hospital of Kaifeng City, Henan 475000,China 　　Abstract：[Objective]To discuss the method and clinical effects of coronal fractures of the femoral condyle treated with open reduction plus cancellous lag screw internal fixation.[Method]From May 1998 to June 2006,17 cases of coronal fractures of femoral condyle were treated with open reduction and cancellous lag screw internal fixation by using anterolateral for typ Ⅰ or typ Ⅲ lateral femoral condylar fracture(LFCF)/anteromedial for type Ⅰ or type Ⅲ medial femoral condylar fracture (MFCF) or posterolateral for type ⅡLFCF/posteromedial approach for type Ⅱ MFCF.There were 15 males and 2 females with the average age 39.5 years,ranging from 19 to 48 years.According to Letenneur classification,there were type Ⅰfracture 7 cases,type Ⅱ 4 cases,and type Ⅲ 6 cases.Among them, 14 cases were closed fracture, 3 eases were open fracture.Auto ilium transplant or homologous allograft bone transplant (5 cases) were also used. All patients were treated with plaster external fixation after operation. The interval between injury and surgery averaged 3.6 days(2.5 hours to 8 days).[Result]All patients were followed up for 8～26 months with an average of 18.2 months.All fractures got bone union with average union