顺势复位技术微创治疗FraserⅡ型浮膝损伤的疗效

目的探讨顺势复位技术微创治疗FraserⅡ型浮膝损伤的临床疗效。方法回顾性分析2016年11月至2018年7月河北医科大学第三医院创伤急救中心采用顺势复位技术微创治疗的7例FraserⅡ型浮膝损伤患者资料。男5例,女2例;年龄30~82岁,平均52岁;7例患者均为浮膝损伤合并胫骨平台骨折,其中FraserⅡA型(胫骨平台骨折伴有股骨干骨折)5例,ⅡC型(胫骨平台骨折伴有股骨髁骨折)2例。应用顺势双反牵引复位器分别闭合复位股骨及胫骨平台骨折,微创置入内固定物。记录手术时间、单个切口平均长度、失血量、透视次数等数据。随访拍摄患者下肢正、侧位X线片,记录骨折愈合时间;末次随访时采用美国特种外科医院膝关节评分(HSS)评估膝关节功能。结果7例患者手术时间平均为87.2 min,单个切口长度平均为2.8 cm,失血量平均为471 mL,透视次数平均为37次。所有患者术后X线均显示骨折对位及力线良好,关节面平整。7例患者切口均为甲级愈合。7例患者术后随访时间为12~21个月(平均15.6个月),骨折愈合时间平均为12.8周。末次随访时患者HSS评分结果显示:优6例,良1例。结论采用顺势双反牵引复位器可分别闭合复位微创固定股骨侧骨折及胫骨侧骨折,可获得较好的膝关节功能。

Minimally invasive treatment of Fraser type Ⅱ floating knee by homeopathic reduction

Objective To evaluate the clinical efficacy of minimally invasive treatment of Fraser typeⅡfloating knee by homeopathic reduction.Methods From November 2016 to July 2018,7 patients with Fraser typeⅡfloating knee were treated by homeopathic reduction and minimally invasive surgery at Trauma Emergency Center,The Third Hospital of Hebei Medical University.They were 5 males and 2 females,aged from 30 to 82 years(average,52 years).They all suffered from tibial plateau fracture complicated with floating knee,with 5 cases of Fraser typeⅡA(tibial plateau fracture complicated with femoral shaft fracture)and 2 cases of Fraser typeⅡC(tibial plateau fracture complicated with femoral condyle fracture).The femoral and tibial plateau fractures were reduced with a bidirectional traction reduction device,followed by minimally invasive implantation of internal fixators.The operation time,length of a single incision,blood loss and fluoroscopic frequency were recorded.The anteroposterior and lateral X-ray films of the lower limb were taken and fracture healing time was recorded during follow-up.The function of knee joint was evaluated by Hospital for Special Surgery(HSS)scoring system at the last follow-up.Results For the 7 patients,operation time averaged 87.2 min,length of a single incision 2.8 cm,blood loss 471 mL,and fluoroscopy frequency 37 times.The postoperative X-ray films showed fine alignment and force line and smooth articular surface in all patients.All the incisions healed by grade A.The follow-up time for 7 patients ranged from 12 to 21 months(average,15.6 months).All the fractures healed after an average time of 12.8 weeks.The HSS scores at the last follow-up showed that 6 cases were excellent and one was good.Conclusion The fractures of the femur side and of the tibia side can be treated separately by closed reduction and internal fixation using a homeopathic bidirectional traction reduction device so as to obtain better knee joint function.