摘要目的 观察手术治疗儿童Hoffa骨折的疗效,探讨儿童Hoffa骨折的手术治疗规范.方法 2003年1月至2013年1月共收治儿童Hoffa骨折病例6例,其中男4例,女2例,平均年龄10岁7个月.受伤原因均为车祸伤.按Salter-Harris分型:4例为Ⅲ型,2例为Ⅳ型.手术采用膝关节纵行内/外侧切口,2/3位于关节平面上,1/3位于关节平面下,沿髌旁前内侧或外侧纵行切口进入关节囊,将髌骨牵开以充分暴露骨折部位.术中需将骨折解剖复位,由前至后向骨折块方向以中空螺钉内固定,注意将钉尾埋于股骨远端关节软骨内.术后无需外固定,术后第二天嘱患儿进行患肢股四头肌等长肌力练习,术后第三周开始膝关节主动功能活动训练.术后6周内严禁负重,术后12周允许完全负重.术后6个月再次手术取出内固定.按照Letenneur评分标准对膝关节康复功能进行评分.结果 所有病例均骨性愈合,骨性愈合时间为术后12～18周,平均15.8周.所有患儿伤肢膝关节功能恢复正常,生长发育正常,无骨骺早闭等并发症发生,无下肢畸形发生.全部病例Letenneur评分为优.结论 儿童Hoffa骨折是关节内、骨骺骨折,临床中非常罕见,很容易漏诊、误诊.儿童Hoffa骨折切开解剖复位、空心螺钉内固定以及早期功能锻炼能够得到长期的满意效果.

abstractsObjective To explore the surgical efficacies of Haffa fracture in children and examine the criteria of surgery for Haffa fracture in children.Methods All injuries were caused by traffic accidents.Six patients of Haffa fracture underwent open reduction and internal fixation with cannulated screws.There were 4 boys and 2 girls with a mean age of 10.7 years.According to the Salter-Harris classification scheme,the clinical types were Ⅲ (n =4) and Ⅳ (n =2).Fractures were exposed through a medial or lateral longitudinal incision of knee.And annulated screws from anterior to posterior were used for securing the end of screws below the surface of joint cartilage.The clinical outcomes were judged by Letenneur knee function score.Results All fractures were unionized.Normal functional knees were recovered with growing development.There were neither early epiphyseal closure nor lower extremity deformity.All Letenneur scores were excellent.Conclusions As a rare and intra-articular condition,Hoffa fracture is frequently neglected and misjudged in children.Open reduction and internal fixation with cannulated screws offers rigid fixation and early rehabilitation.