Demirel Murat, Dereboy Ferit, Ozturk Ali, Turhan Egemen
Department of Orthopaedics & Traumatology, Ankara Bayindir Hospital, Ankara, Turkey.
Arthroscopy. 2006 Jun;22(6):690.e1-4. doi: 10.1016/j.arthro.2005.08.049.
As with any other intra-articular fracture, the distal intra-articular femoral fracture has always been a challenge for orthopaedic surgeons because of the wide variety of trauma with which it is associated, and because associated soft-tissue injuries further augment its complexity. In articular fractures of the distal femur, arthroscopy allows rinsing of the articulation to visualize and also to assess intra-articular meniscal or ligamentous lesions, as well as the quality of the reduction. After a fall from a ladder, a 34-year-old man experienced a distal femoral intra-articular fracture (type B1) on the left side. Standard arthroscopic portals were used and the joint was irrigated and blood clots were evacuated. Through a lateral incision, 2 guidewires were placed perpendicular to the fracture. Cannulated 6.5-mm screws with washers were threaded over the guidewires and compression and anatomic reduction of the fracture site was obtained. The reduction quality was confirmed arthroscopically after irrigation. The fracture was shown to have healed radiographically and clinically by 3 months and the patient was back to work without limitations. Instead of using an arthrotomy for Müller type B1 lateral femoral condyle fractures, internal fixation assisted with arthroscopy will be a valuable technique with the advantage of identifying associated intra-articular pathology.
与其他任何关节内骨折一样，股骨远端关节内骨折一直是骨科医生面临的一项挑战，这是因为与之相关的创伤种类繁多，而且相关的软组织损伤进一步增加了其复杂性。在股骨远端关节骨折中，关节镜检查可用于冲洗关节，以观察并评估关节内半月板或韧带损伤以及复位质量。一名34岁男性从梯子上跌落之后，左侧发生了股骨远端关节内骨折（B1型）。使用标准关节镜入路，对关节进行冲洗并清除血凝块。通过外侧切口，将2根导丝垂直于骨折部位置入。将带垫圈的6.5毫米空心螺钉拧在导丝上，对骨折部位进行加压并实现解剖复位。冲洗后通过关节镜检查确认复位质量。3个月时，骨折在影像学和临床检查中均显示已愈合，患者恢复工作且无任何限制。对于Müller B1型股骨外侧髁骨折，不采用切开手术，而是采用关节镜辅助下的内固定将是一项有价值的技术，其优点是能够识别相关的关节内病变。
