本文選題：Hoffa骨折　切入點(diǎn)：側(cè)方支撐鋼板　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:本研究通過(guò)搜集發(fā)生在單膝外側(cè)髁上的Letenneur I型Hoffa骨折,并采用側(cè)方支撐鋼板輔助拉力螺釘?shù)姆椒ㄖ委熁驊?yīng)用單純使用拉力螺釘?shù)姆椒ㄖ委煹牟±?采用對(duì)比分析,來(lái)探討兩種術(shù)式中哪種術(shù)式治療發(fā)生在單膝外側(cè)髁上的Letenneur I型Hoffa骨折在骨折愈合時(shí)間和膝關(guān)節(jié)功能恢復(fù)等臨床療效方面更具有優(yōu)勢(shì)。材料與方法:在研究期間(2000年1月-2016年1月)收治在大連醫(yī)科大學(xué)第二附屬醫(yī)院,并且術(shù)中確診為發(fā)生在單膝外側(cè)髁上的Letenneur I型Hoffa骨折的患者,依照排除標(biāo)準(zhǔn)剔除資料不全丟失及失訪者等選取符合診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)共有42例,對(duì)其進(jìn)行回顧性分析。所有骨折均通過(guò)外側(cè)入路采用側(cè)方支撐鋼板輔助拉力螺釘?shù)姆椒ㄖ委熁騿渭兪褂美β葆數(shù)姆椒ㄖ委?分別標(biāo)為A組、B組,例數(shù)分別有24例、18例。在術(shù)后早期積極行康復(fù)鍛煉。通過(guò)查閱手術(shù)記錄對(duì)術(shù)中出血量進(jìn)行對(duì)比分析,通過(guò)查閱影像學(xué)、骨折愈合標(biāo)準(zhǔn)對(duì)骨折愈合時(shí)間進(jìn)行對(duì)比分析,采用Letenneur膝關(guān)節(jié)術(shù)后評(píng)分、膝關(guān)節(jié)KSS評(píng)分以調(diào)查問(wèn)卷形式對(duì)膝關(guān)節(jié)的穩(wěn)定性、功能結(jié)果等進(jìn)行優(yōu)良率的對(duì)比分析。結(jié)果:術(shù)后切口均Ⅰ期愈合,骨折在所有單膝股骨遠(yuǎn)端外側(cè)髁Hoffa骨折患者中均達(dá)到了愈合,無(wú)早期并發(fā)癥發(fā)生。股骨外髁關(guān)節(jié)面達(dá)到解剖復(fù)位。通過(guò)術(shù)后早期積極的康復(fù)鍛煉,多數(shù)患者達(dá)到滿意的膝關(guān)節(jié)功能,恢復(fù)了行走能力,達(dá)到了臨床好結(jié)果。A組術(shù)后遠(yuǎn)期并發(fā)癥發(fā)生率為16.67%,術(shù)中平均出血量140±15.65ml,骨折平均愈合時(shí)間為12.32±1.21周,采用Letenneur膝關(guān)節(jié)術(shù)后評(píng)分18例獲得優(yōu)良,優(yōu)良率達(dá)75%,采用膝關(guān)節(jié)KSS評(píng)分19例獲得優(yōu)良,優(yōu)良率達(dá)79.17%。B組術(shù)后遠(yuǎn)期并發(fā)癥發(fā)生率為27.78%,術(shù)中平均出血量102±12.32ml,骨折平均愈合時(shí)間為11.67±1.10周,采用Letenneur膝關(guān)節(jié)術(shù)后評(píng)分13例獲得優(yōu)良,優(yōu)良率達(dá)72.22%,采用膝關(guān)節(jié)KSS評(píng)分13例獲得優(yōu)良,優(yōu)良率達(dá)72.22%。兩組數(shù)據(jù)經(jīng)過(guò)t檢驗(yàn)得到,在術(shù)中平均出血量、骨折愈合時(shí)間方面沒(méi)有統(tǒng)計(jì)學(xué)差異。兩組數(shù)據(jù)經(jīng)過(guò)卡方檢驗(yàn)得到,在術(shù)后膝關(guān)節(jié)功能評(píng)分方面沒(méi)有統(tǒng)計(jì)學(xué)差異。結(jié)論:在應(yīng)用側(cè)方支撐鋼板輔助拉力螺釘或單純拉力螺釘治療發(fā)生在股骨遠(yuǎn)端單膝外側(cè)髁上的Letenneur I型Hoffa骨折時(shí),兩種方法療效明顯,膝關(guān)節(jié)功能達(dá)到令人滿意的結(jié)果,兩者均是目前治療Letenneur I型Hoffa骨折時(shí)常用的有效方法。單純拉力螺釘治療可能具有術(shù)中平均出血量少的優(yōu)點(diǎn),而兩種方法在骨折愈合時(shí)間上并沒(méi)有明顯差異。
[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 鹵15.65ml, and the average healing time of fracture was 12.32 鹵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 鹵12.32 ml, and the average healing time of fracture was 11.67 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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