两种术式治疗Letenneur Ⅰ型外侧髁Hoffa骨折的疗效对比分析

发布时间：2018-03-12 13:34

本文选题：Hoffa骨折　切入点：侧方支撑钢板　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究通过搜集发生在单膝外侧髁上的Letenneur I型Hoffa骨折,并采用侧方支撑钢板辅助拉力螺钉的方法治疗或应用单纯使用拉力螺钉的方法治疗的病例,采用对比分析,来探讨两种术式中哪种术式治疗发生在单膝外侧髁上的Letenneur I型Hoffa骨折在骨折愈合时间和膝关节功能恢复等临床疗效方面更具有优势。材料与方法:在研究期间(2000年1月-2016年1月)收治在大连医科大学第二附属医院,并且术中确诊为发生在单膝外侧髁上的Letenneur I型Hoffa骨折的患者,依照排除标准剔除资料不全丢失及失访者等选取符合诊断标准及纳入标准共有42例,对其进行回顾性分析。所有骨折均通过外侧入路采用侧方支撑钢板辅助拉力螺钉的方法治疗或单纯使用拉力螺钉的方法治疗,分别标为A组、B组,例数分别有24例、18例。在术后早期积极行康复锻炼。通过查阅手术记录对术中出血量进行对比分析,通过查阅影像学、骨折愈合标准对骨折愈合时间进行对比分析,采用Letenneur膝关节术后评分、膝关节KSS评分以调查问卷形式对膝关节的稳定性、功能结果等进行优良率的对比分析。结果:术后切口均Ⅰ期愈合,骨折在所有单膝股骨远端外侧髁Hoffa骨折患者中均达到了愈合,无早期并发症发生。股骨外髁关节面达到解剖复位。通过术后早期积极的康复锻炼,多数患者达到满意的膝关节功能,恢复了行走能力,达到了临床好结果。A组术后远期并发症发生率为16.67%,术中平均出血量140±15.65ml,骨折平均愈合时间为12.32±1.21周,采用Letenneur膝关节术后评分18例获得优良,优良率达75%,采用膝关节KSS评分19例获得优良,优良率达79.17%。B组术后远期并发症发生率为27.78%,术中平均出血量102±12.32ml,骨折平均愈合时间为11.67±1.10周,采用Letenneur膝关节术后评分13例获得优良,优良率达72.22%,采用膝关节KSS评分13例获得优良,优良率达72.22%。两组数据经过t检验得到,在术中平均出血量、骨折愈合时间方面没有统计学差异。两组数据经过卡方检验得到,在术后膝关节功能评分方面没有统计学差异。结论:在应用侧方支撑钢板辅助拉力螺钉或单纯拉力螺钉治疗发生在股骨远端单膝外侧髁上的Letenneur I型Hoffa骨折时,两种方法疗效明显,膝关节功能达到令人满意的结果,两者均是目前治疗Letenneur I型Hoffa骨折时常用的有效方法。单纯拉力螺钉治疗可能具有术中平均出血量少的优点,而两种方法在骨折愈合时间上并没有明显差异。
[Abstract]:Objective: to collect the patients with Letenneur type I Hoffa fracture on the lateral condyle of one knee and treated with lateral support plate assisted pull screw or single pull screw. To explore which of the two surgical procedures for the treatment of Letenneur type I Hoffa fracture occurred on the lateral condyle of one knee has more advantages in healing time and functional recovery of knee joint. Materials and methods: during the study period:. Admitted to the second affiliated Hospital of Dalian Medical University from January to January 2016, According to the exclusion criteria, 42 patients with Letenneur type I Hoffa fracture diagnosed on the lateral condyle of one knee were selected according to the exclusion criteria, such as incomplete data loss and missing visit, which met the diagnostic criteria and inclusion criteria. All fractures were treated by lateral support plate assisted pull screw or only by pull screw. All fractures were marked as group A and group B, respectively. There were 24 cases and 18 cases respectively. Early rehabilitation exercise was performed in the early postoperative period. The amount of intraoperative bleeding was compared and analyzed by consulting the operative records, and the time of fracture healing was compared with the standard of fracture healing by looking up the imaging images and the standard of fracture healing. Letenneur knee joint postoperative score and knee joint KSS score were used to analyze the excellent and good rate of knee joint stability and functional results by questionnaire. Results: all the incisions healed in the first stage after operation. The fracture was healed in all patients with Hoffa fracture of the lateral femoral condyle of the distal femur, no early complications occurred, and the articular surface of the lateral femoral condyle was anatomically reduced. Most of the patients achieved satisfactory knee function and recovered walking ability. The long-term complication rate of group A was 16.677.The average blood loss during operation was 140 卤15.65ml, and the average healing time of fracture was 12.32 卤1.21 weeks. Letenneur score was used in 18 cases, the excellent and good rate was 75%, and the knee joint KSS score was good in 19 cases. The excellent and good rate was 27.78% in group B. The average blood loss during operation was 102 卤12.32 ml, and the average healing time of fracture was 11.67 卤1.10 weeks. The Letenneur score was used in 13 cases, the excellent and good rate was 72.22, the KSS score of knee joint was good in 13 cases, and the excellent and good rate was 72.22.The data of the two groups were obtained by t test, and the average amount of bleeding during operation was obtained. There was no statistical difference in fracture healing time. Two groups of data were obtained by chi-square test. There was no significant difference in knee function score after operation. Conclusion: in the treatment of Letenneur type I Hoffa fracture with lateral support plate assisted pull screw or simple pull screw, the lateral supracondylar fracture of the distal femur occurred. The two methods have obvious curative effect and satisfactory results of knee joint function. Both of them are commonly used in the treatment of Letenneur type I Hoffa fracture at present. The treatment of single pull screw may have the advantage of less average blood loss during operation. There was no significant difference in fracture healing time between the two methods.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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