合并伸膝装置损伤的hoffa骨折的治疗

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1、合并伸膝装置损伤的Hoffa骨折的治疗【摘要】研究合并伸膝装置损伤的Hoffa骨折的伤情特点和治疗方法。［方法］本院近6年治疗4例Hoffa骨折伴伸膝装置损伤患者均系多发伤，伴同侧肢体骨折及不同程度的髌旁支持带和关节囊的撕裂伤。伸膝装置损伤部位包括1例髌韧带远端撕脱，2例髌韧带近端撕脱，1例股四头肌腱撕裂。单侧双髁骨折3例，均不伴有交叉韧带损伤。单侧单髁骨折1例，同时合并前、后交叉韧带和内侧副韧带损伤。3例开放性骨折行急诊清创、骨折复位拉力螺钉内固定，伸膝装置修复、减张钢丝固定。1例闭合性骨折伤后1周全身情况稳定后再行手术。合并同一肢体骨折者同时行手术复位内固

2、定。术后石膏伸直位制动4～6周开始功能锻炼。［结果］4例患者伤口均Ⅰ期愈合，未出现感染及皮肤坏死。通过6个月～3年的随访，4例7髁均达骨性愈合，愈合时间为6～12周。根据Letenneur等的Hoffa骨折术后功能评估标准综合评估：优良1例，可3例。［结论］合并伸膝装置损伤的Hoffa骨折常伴有合并伤。开放性损伤宜急诊手术，一期固定骨折及修复伸膝装置。减张钢丝固定可增强伸膝装置的稳定，便于术后早期功能锻炼。【关键词】Hoffa骨折股骨髁伸膝装置损伤治疗Abstract：［Objective］Toinvestigatetheinjurycharacteristi

3、csandtreatmentoftheHoffafactureassociated12withextensormechanisminjury.［Method］FourpatientswithHoffafactureassociatedwithextensormechanisminjurytreatedinauthor'shospitalinrecent6yearswereenrolledinthisstudy.Allthepatientsweremultiple-injured,andassociatedwiththeipsilaterallimbfractu

4、reandretinacularandcapsulelaceration.Thesiteoftheextensormechanisminjuryincluded1distalpatellartendondisruption,2proximalpatellartendondisruption,and1distalquadricepstendondisruption.Nocruciateligamentinjurywasfoundin3ipsilateralbicondylarfractures.Oneunicondylarfracturewasassociate

5、dwithanteriorandposteriorcruciateligamentandmedialcollateralligamentinjurysimultaneously.Emergencyoperationwasperformedalongwiththedebridementinthethreeopenfractures.Inanotherpatientwithclosedfracture,operationwasperformedoneweekafterinjury.Fractureswerereducedandfixedwithlagscrews.

6、Extensorapparatuswererepairedandstrengthenedwithatensionbandwirethroughbothpatellaandtibia.Ipsilaterallimbfractureswerereducedandinternalfixedwithhardwaresimultaneously.Thekneeswereimmobilizedinextensionwithcastafteroperation,andflexionexercisewascommencedfourtosixweekslater.［Result

7、］Fourpatientswoundsreachedthefirstratehealing.Therewasnoinfectionandnecrosisofskin.All12patientswerefollowed-upforsixmonthstothreeyears.All7condylesofthe4patientsreachedboneunion.Healingtimewasaboutsixtotwelveweeks.AccordingtoLetenneur’sfunctionalassessmentsystem,excellentandgoodres

8、ultswerein1cases,fi