Objective To investigate the operative management of isolated Hoffa fractures and its clinical effect. Methods A total of 18 patients with 19 Hoffa fractures, including 17 single-condylar fractures (11 lateral con-dyles and 6 medial condyles) and one double-condylar fracture, were surgically treated from January 2005 to December 2011. There were 11 males and 7 females, with an mean age of 32.3 years (ranged from 18 to 55 years). Of all the fractures, 8 were classified as Letenneur type Ⅰ fracture, 2 as type Ⅱ fracture and 9 as type Ⅲ fracture. An open approach with a medial or lateral parapatellar arthrotomy was used for reduction and 2 or 3 lag screws were inserted in a posterior-anterior direction for internal fixation. All the patients were well followed up, with an average period of 20.6 months (ranged from 6 to 43 months). The clinical outcome was assessed according to the criteria proposed by Letenneur. Results Union was achieved in all patients. There was no infection, fixation loosening, displacement or con-dyle ischemic necrosis. According to the criteria proposed by Letenneur, 14 patients had excellent-good outcome, 3 had fair outcome and 1 had poor outcome, with the excellent and good rate of 77.8%. Conclusion Open reduction and interfixation with lag screws followed by early mobilization is an effective treatment for Hoffa fracture.%目的 探讨单纯Hoffa 骨折的手术治疗方法,并观察其临床疗效.方法 2005 年1 月至2011 年12月手术治疗单纯Hoffa 骨折18 例,男11 例,女7 例,年龄18~55 岁,平均32.3 岁.单髁骨折17 例,其中外髁11 例,内髁6 例,双髁骨折1 例.Letenneur Ⅰ型8 例,Ⅱ型2 例,Ⅲ型8 例.手术入路采取前方髌旁内侧/外侧入路,应用2~3 枚松质骨拉力螺钉由后向前固定,术后伸膝位石膏外固定2 周.随访时间6~43 个月,平均20.6 个月.疗效评定参照Letenneur等的Hoffa 骨折术后功能恢复评估标准进行评定.结果 所有病例均骨性愈合,无膝关节感染、内固定松动、骨折块移位和骨折块缺血坏死等并发症.根据Letenneur等的Hoffa骨折术后功能恢复评估标准,优14 例,可3例,差1 例,优良率为77.8%.结论 切开复位、拉力螺钉内固定和术后早期功能锻炼是治疗单纯Hoffa骨折的有效方法,临床疗效满意.
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