老年股骨髁部骨折的治疗分析

目的探讨治疗老年股骨髁部骨折的内固定器选择及应用要点。方法治疗82例老年股骨髁部骨折,A型26例,B型17例,C型39例。分别采用95°角翼钢板(19例)、T型钢板(5例)、AO股骨髁支持钢板(11例)、动力髁螺钉(dynamiccondylarscrew,DCS)(23例)、股骨髁上带锁髓内钉(greenseligsenhenry,GSH)(24例)进行治疗,共28例采用自体髂骨或同种异体骨植骨。结果经平均14.6个月随访,按Merchan等评分标准评定膝关节功能,总优良率为90.2%。结论老年股骨髁部骨折具有特殊性,针对骨折类型选择内固定器是治疗的重要环节。手术的关键在于保持股骨髁关节面的完整性和牢固固定。     

股骨髁冠状面骨折的分型与治疗

目的 探讨股骨髁冠状面骨折的分型与治疗方法。方法 对1999年3月-2005年12月治疗的9例（12髁）股骨髁冠状面骨折患者，采用改良Letenneur分型：Ⅰ型5例6髁，Ⅱ型2例2髁，Ⅲ型2例4髁。根据骨折类型和伤情特点分别行前外（内）侧、后外（内）侧及膝前马蹄形切口入路显露，直视下复位，松质骨拉力螺钉或克氏针内固定。结果 所有患者获得6个月～2年随访，骨折均获骨性愈合，愈合时间为6～12周，无骨不愈合及骨坏死发生。根据Letenneur等的Hoffa骨折术后功能评估标准：优良5例，可4例。结论 切开复位拉力螺钉内固定是治疗股骨髁冠状面骨折的主要方法，Ⅰ、Ⅲ型骨折宜用前外侧或内侧入路，Ⅱ型骨折则宜用后外侧或内侧入路。合并伸膝装置损伤的双髁骨折，则膝前马蹄形切口显露较充分。     

外伤性股骨髁部负重区软骨缺损的治疗

目的探讨外伤性股骨髁部负重区软骨缺损的治疗并对治疗方法进行献回顾。方法2000年至今共处理股骨髁部骨折20余例，其中2例为股骨髁部骨折并负重区关节软骨全层缺损，另有1例刀砍伤致负重区关节软骨全层缺损。合并股骨髁部骨折首先复位固定骨折，然后软骨缺损以骨膜移植进行修复；刀砍伤所致软骨缺损行磨削关节成形术结果按照Brittberg-Peterson功能评定标准评定，例1随访1年，评分21分；例2随访8个月，评分29分；例3随访6个月，评分4分结论单纯软骨缺损采用骨膜移植疗效一般；采用磨削关节成形术效果较好，与献回顾疗效相吻合。     

动力髁钉板内固定治疗股骨髁C型骨折

目的 探讨动力髁钉板(DCS)内固定治疗股骨髁C型骨折的临床疗效。方法 对15例股骨髁C型骨折的患者行DCS内固定。结果 患者骨折于5～10月内愈合，平均6个月。参照Shelbourne疗效标准：优8例，良5例，可2例。优良率86．7％。结论 DCS设计合理、操作方便、固定可靠。DCS治疗股骨髁C型骨折，术后可早期功能锻炼，疗效满意。     

Coronal fractures of the distal femoral condyle: a biomechanical evaluation of four internal fixation constructs

This study evaluated different fixation methods in posterior femoral condyle coronal fractures. A standardised osteotomy was created in synthetic composite femurs and fixed with one of four methods (one 3.5 mm diameter screw, two 3.5 mm screws, one 6.5 mm screw, two 6.5 mm screws). The stiffness and mean loads to specified displacements were measured. The stiffness of two 6.5 mm screws was significantly greater than both single 3.5 mm screw (3567 versus 2584N/mm; p=0.0075) and double 3.5 mm screws (3567 versus 2080N/mm; p=0.003). There was no statistical difference in the stiffness of one 6.5 mm screw compared to either the single or double 3.5mm screws. Increasing the screw diameter and using two screws increased the load at 1, 2 and 3 mm of displacement. In the fixation of posterior femoral condyle fractures, two 6.5 mm screws are more rigid than either single or double 3.5 mm screws. The use of a second screw marginally increases the rigidity of fixation. If 3.5 mm screws are used in the fixation of posterior femoral condyle fractures, at least two screws should be used to approximate the biomechanical stability of a single 6.5 mm screw.     

Spontaneous osteonecrosis of the lateral femoral condyle of the knee: a report of 11 cases

BACKGROUND: Spontaneous osteonecrosis (SON) of the lateral femoral condyle of the knee joint is very rare and there have been only a few articles about this condition. MATERIALS: We reviewed data for 11 patients (7 men, 4 women) with unusual SON of the lateral femoral condyle of the knee. The average age of patients at onset was 61.9 years (range 47-76 years). No patient had underlying disease or had undergone steroid therapy, although one underwent lateral meniscectomy. RESULTS: According to Aglietti's radiographic classification, three patients had stage 1 disease, two had stage 2 disease, three had stage 3 disease, one had stage 4 disease, and two had stage 5 at first examination. The average alignment of affected limbs on standing was 5.9 degrees valgus (range 0 degrees -11 degrees ). Although the osteonecrotic lesion was seen on the lateral side, the mechanical axis passed the medial compartment in three patients. Six patients were treated conservatively and the remaining five required surgery, which consisted of lateral unicompartmental knee arthroplasties. CONCLUSION: The pathology of the necrosis of the lateral femoral condyle was considered to be different from that of the medial femoral condyle regarding clinical features, limb alignment, and radiographic findings.     

Osteonecrosis of the femoral condyles: A retrospective study of 34 cases

Summary The authors report 34 cases of osteonecrosis of the femoral condyles (28 of the medial condyle and 6 of the lateral condyle). This disorder particularly affects elderly women; the quest for an etiology is often negative, apart from a genu varum noted in half the cases. Conventional radiography provided the diagnosis in three-quarters of the cases; in the other cases MRI was the examination of choice, except in multifocal forms where radionuclide bone scanning remains very useful. The course was spontaneously favorable in 5 cases. Surgery has been increasingly used in recent years: valgus osteotomy in 5 cases, a unicompartmental prosthesis in 11 cases, and total knee replacement in 3 cases.     

Bone marrow pressure in osteonecrosis of the femoral condyle (Ahlb?ck's disease)

Concerning the clinical, radiographic, and scintigraphic aspects of Ahlb?ck's disease, there are similarities with avascular necrosis of the femoral head. In 1980, therefore, we introduced a method of measuring bone marrow pressure which had been used in cases of osteoarthritis and pain in the knee. The measurement is done in the medial and lateral femoral condyle and in the medial part of the tibial head. Our findings were increased values in all stages of the disease, indicating that early (preradiographic) diagnosis and a differential diagnosis between osteoarthritis and osteonecrosis are possible using this method alone. We treat the earliest stages by core biopsy only (the bone cylinder is sent for histological classification) and have had very good results to date.     

Bone marrow pressure in osteonecrosis of the femoral condyle (Ahlbäck's disease)

Summary Concerning the clinical, radiographic, and scintigraphic aspects of Ahlbäck's disease, there are similarities with avascular necrosis of the femoral head. In 1980, therefore, we introduced a method of measuring bone marrow pressure which had been used in cases of osteoarthritis and pain in the knee. The measurement is done in the medial and lateral femoral condyle and in the medial part of the tibial head. Our findings were increased values in all stages of the disease, indicating that early (preradiographic) diagnosis and a differential diagnosis between osteoarthritis and osteonecrosis are possible using this method alone. We treat the earliest stages by core biopsy only (the bone cylinder is sent for histological classification) and have had very good results to date.     

Pathological fracture of the femoral neck as the first manifestation of osteonecrosis of the femoral head

We describe two cases of pathological fracture of the femoral neck occurring as the first manifestation of osteonecrosis of the femoral head (ONFH). No abnormal findings suggestive of ONFH were identified on the radiographs for either of the patients, and the fractures occurred like spontaneous fractures without any trauma or unusually increased activity. The patients' medical history, age, and good bone quality suggested ONFH as a possible underlying cause of the fractures. If we had not suspected ONFH as a predisposing condition, these minimally displaced fractures might have been fixed internally with multiple pins, and this would have led to nonunion or collapse of the femoral head. To avoid inappropriate treatment, ONFH should be considered as a predisposing factor in pathological fractures of the femoral neck. Received: November 20, 1999 / Accepted: July 22, 2000     

空心钉治疗股骨外髁冠状面骨折

2009年8月～2010年12月,我科应用空心钉治疗11例股骨外髁冠状面骨折患者,取得良好疗效。1材料与方法1.1病例资料本组11例,男8例,女3例,年龄18～56岁。均为闭合性骨折。骨折按Letenneur et al分类[1]:Ⅰ型2例,Ⅱ型8例,Ⅲ型1例。术前患者均     

晚期股骨头坏死的人工关节置换术

[目的]探讨晚期股骨头坏死患者髋关节置换术的选择方法及其临床结果。[方法]对本科于1985年5月～2003年12门行髋关节置换术的119例（138髋）股骨头坏死患者进行了随访。使用人工双极股骨头置换术及THA治疗晚期股骨头坏死者分别为29例（31髋），90例（107髋）。所有手术均采用后外侧人路。[结果]早期使用的国产骨水泥人工双极股骨头假体，86．7％的股骨柄假体出现松动。全骨水泥THA，50％髋出现了髋臼杯似体松动，62．5％髋股骨柄似体松动，25％髋行全髋人工关节翻修术：混合型（Hybrid）THA，未出现髋臼杯及股骨柄似体的松动，非骨水泥THA，除1例外无髋臼杯及股骨柄假体松动或下沉。[结论]使用人工双极股骨头置换术治疗晚期股骨头坏死应慎重选择，可适用于老年、日常活动量小的患者；而对于年轻患者，非骨水泥型THA为最佳选择；对于股骨侧出现骨质疏松或不适合使用生物固定型股骨柄假体的患者，混合型（Hybrid）THA同样可以获得满意疗效；全骨水泥犁THA应很少使用。     

Nonunion of coronal shear fracture of femoral condyle

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.     

Iliac bone graft for steroid-associated osteonecrosis of the femoral condyle

The use of steroid medication may predispose to osteonecrosis of the femoral condyle. However, there is a controversy regarding treatment of this disease, especially for lesions in advanced stages. Since 1987, the authors have treated such lesions by autologous osteoperiosteal graft obtained from the iliac bone. When limb alignment was affected by the disease, proximal tibial valgus or varus osteotomy was done concomitantly. The rationale for this method is to replace the necrotic bone and damaged cartilage by autogenous bone and periosteum, anticipating the chondrogenic potential of the latter. In this study, 10 knees in eight patients were reviewed to learn the outcome of this procedure with a mean followup of 79 months (range, 32-158 months). The grafts were incorporated successfully in nine joints, and satisfactory results were achieved in all patients. Therefore autologous iliac bone graft is a promising alternative for treatment of osteonecrosis, especially when patients are young and physically active.     

Retrograde intramedullary nailing for the treatment of femoral medial condyle fracture nonunion

An unicondylar fracture of the femur is uncommon and of the medial condyle more so. Open reduction and internal fixation of these fractures is most commonly performed with screws or plate and screws. Secure bone fixation is compromised by osteoporosis in elderly patients; additional measures may be required. We report the case of an elderly osteoporotic patient with a medial condyle fracture nonunion treated successfully through retrograde intramedullary nailing. A 78-year-old osteoporotic woman suffered medial condyle fracture of the femur 9 months before visiting our hospital. She had been treated conservatively, and the fracture demonstrated a complete nonunion with gross instability. The edge fragments appeared sclerotic, and the nonunion site was accompanied by a bony defect. Although fixation by a plate and screw is the standard method for the treatment of such fracture, we judged that stability would be difficult to achieve with this method due to the accompanying bony defect and osteoporosis. Thus, we performed open reduction and fixation by retrograde intramedullary nailing with the use of “condyle screw and nut” system, followed by bone grafting. Bony union was successfully obtained. The stability and range of motion of the knee were recovered, and the patient regained the ability to walk. We suggest the unique application of retrograde intramedullary nailing with condyle screw and nut for the treatment of specific, complex cases of femoral medial condyle fracture.