本研究旨在以股骨远端骨折合并脱位病例的解剖特点为侧重，创建一种更加可靠的分类系统，为临床治疗提供一定的借鉴意义。

纳入温州医科大学附属第二医院2012年8月至2024年1月，因外伤导致股骨髁骨折并伴有膝关节脱位入院，且有完整影像资料（X线+CT）的患者。排除病理性或陈旧性骨折、影像资料不清或缺失、以及随访记录不完整的患者。为了创建骨折脱位分类系统，由1名创伤骨科主任医生以及其他9名创伤骨科主治医生组成的研究员组对90个病例进行讨论，最终建立了新的分类系统。再根据Fleiss kappa、Cohen’s kappa检验确定了10名独立评价员的观察者间以及观察者内的可靠性，提出临床标准化诊疗方案。

建立的新分类系统分为三类：A类，股骨远端骨折合并髌股关节脱位；B类，股骨远端骨折合并胫股关节脱位；C类，股骨远端Hoffa骨折合并膝关节脱位。研究员组的观察者内一致性均值为κ=0.923，评价员组的为κ=0.931。以新分类系统为基础，获得了临床标准化诊疗流程。

研究表明，新的股骨远端骨折-脱位分类系统对股骨远端骨折具有很高观察者间的可靠性。新分类系统结合骨折和脱位两种损伤，能够处理传统分类系统无法归类的受伤情况，因此这将有助于临床医生更好地交流并选择适当的治疗方案。

To develop a reliable classification system based on the anatomical characteristics of distal femoral fractures combined with dislocations, thereby providing a reference for clinical management.

Patients with femoral condylar fractures and knee dislocations caused by trauma, who had complete imaging data (X-ray and CT), were included between August 2012 and January 2024. Those with pathological or old fractures, unclear or missing imaging data, or incomplete follow-up records were excluded. To establish the fracture-dislocation classification system, a research team consisting of one director and nine attending physicians in orthopedic trauma reviewed and discussed 90 cases, ultimately developing a new classification system. Inter- and intra-observer reliability was determined using Fleiss’ kappa and Cohen’s kappa tests by ten independent evaluators, leading to the proposal of a standardized clinical management protocol.

The newly established classification system categorized cases into three types. Type A: distal femoral fracture with patellofemoral joint dislocation; type B: distal femoral fracture with tibiofemoral joint dislocation; type C: distal femoral Hoffa fracture with knee joint dislocation.The mean intra-observer agreement was κ= 0.923 among the ten research team members, and the mean intra-observer agreement was κ=0.931 among the ten evaluators. Based on the new classification system, a standardized clinical diagnostic and treatment workflow was established.

The study demonstrates that the new classification system for distal femoral fracture-dislocations exhibits high inter-observer reliability. By integrating both fracture and dislocation components, this system effectively addresses injury patterns that traditional classifications fail to categorize, thereby assisting clinicians in optimizing workflow and selecting appropriate treatment strategies.