Hoffa骨折并内侧副韧带撕脱手术与快速康复△

Surgical treatment and rapid rehabilitation of Hoffa fracture complicated with medial collateral ligament avulsion

摘要:

[目的]介绍 Hoffa 骨折并内侧副韧带撕脱骨折的手术技术与快速康复方法和初步临床效果。[方法]2016 年 5 月— 2021 年 3 月收治内侧 Hoffa 骨折伴内侧副韧带起点撕脱骨折患者 3 例，均采用经内侧切口骨折切开复位钢板螺钉及全螺纹空心钉坚强固定，内侧副韧带止点空心拉力螺钉固定，辅助爱惜邦缝线加强固定，术后将膝关节屈曲 110°~120°放置，镇痛泵止痛，行踝关节功能锻炼以及股四头肌等长收缩训练。24 h 后行膝关节伸屈功能锻炼，3 次/d，每次 30 min，锻炼后膝关节继续屈曲 110°~120°固定共 3 d，3 d 后根据膝关节伸屈功能情况决定膝关节放置体位。[结果]3 例患者均顺利完成手术，术中无血管、神经损伤等严重并发症。患者切口均一期愈合。术后 2 个月膝关节屈曲 ROM 为 （142.3±8.7）°，末次随访，膝关节 HSS 评分为（85.4±5.1）分，膝关节功能恢复良好，无膝关节僵硬发生。骨折愈合时间 3~6 个月，至末次随访时，所有骨折愈合良好，未出现内固定松动移位、修复的韧带再断裂等不良影像改变。[结论]Hoffa 骨折并内侧副韧带起点撕脱骨折，行切开复位坚强固定后，膝关节屈曲 110°~120°固定，配合早期功能锻炼，能加速膝关节功能的康复，减少并发症的发生。

关键词:膝关节;Hoffa 骨折;内侧副韧带;开放复位内固定;快速康复

Abstract:

[Objective] To introduce the techniques and preliminary clinical results of surgical treatment and rapid rehabilitation of Hoffa fracture accompanied with medial collateral ligament avulsion fracture. [Methods] From May 2016 to March 2021, 3 patients re- ceived abovementioned treatment for the medial Hoffa fracture complicated with avulsion fracture at the origin of the medial collateral liga- ment. All the patients underwent open reduction and internal fixation with full-thread cannulated screws and medial plate through the medi- al incision. In addition, lag cannulated screws was used to fix the insertion of the medial collateral ligament with reinforcement by Ethicon suture. After operation, the knee was placed at 110°~120° of flexion, while analgesic pump used for pain relief and ankle pump exercise and quadriceps isometric contraction training were performed. Twenty-four hours later, knee extension-flexion exercise was performed 3 times a day with 30 minutes each time. After exercise, the knee joint was fixed at 110°~120° for a total of 3 days. After 3 days, the knee po- sition was determined according to the knee extension-flexion function. [Results] All the 3 patients had operation performed successfully without serious complications, such as vascular and nerve injury, and got incisions healed well. The knee extension-flexion range of motion (ROM) was of (142.3±8.7)° at 2 months after operation, whereas the HSS score was of (85.4±5.1) at the latest follow-up. All the patients had knee function recovered well without knee stiffness, while got fractures healed well on the radiographs with healing time of 3~6 months., whereas no adverse imaging changes such as internal fixation loosening and displacement, refracture of the repaired ligament occurred. [Conclusion] After open reduction and internal fixation of Hoffa fracture complicated with avulsion fracture of medial collateral ligament, maintaining 110°~120° knee flexion fixation and early functional exercise do accelerate the rehabilitation of knee function and reduce the occurrence of complications.

Key words:knee; Hoffa fracture; medial collateral ligament; open reduction and internal fixation; rapid rehabilitation