摘要
目的探讨微创稳定系统(lessinvasivestabilizationsystem,LISS)治疗股骨远端、胫骨近端骨折的疗效,并分析术中相关因素。方法自2003年7月至2005年3月,应用瑞士Mathys公司的LISS钢板治疗16例17处骨折。男11例,女5例;平均年龄39岁(19￣58岁)。股骨远端骨折9处,胫骨近端骨折8处,其中1例为同侧股骨远端、胫骨近端骨折。手术采用间接复位(关节内骨折除外),微创切口,经骨膜外和肌肉之间插入钢板,经皮小切口将带锁定头的螺钉与钢板的螺孔单皮质锁定。仅对1例伤后21d且开放复位者给予植骨。结果术后平均随访15个月(5￣25个月),骨折全部愈合。3例内固定器已取出。膝关节功能按照患者的主观感受及客观检查结果以Karlstr!m评分法进行评估。优10例,良3例,可3例,优良率81%。1例Ⅱ期骨折复位丢失,但未影响骨折愈合及功能恢复。所有病例无感染发生。无内固定器的钢板及螺钉脱出和断裂。结论LISS钢板设计独特,可保护骨膜及骨折部位血运,促进骨折愈合和功能恢复。LISS所具备的生物学接骨特性为股骨远端、胫骨近端骨折提供了新的治疗方法;然而作为一种以全新理念设计的新型内固定器,临床应用过程中除要加强对理念的理解外,亦要严格掌握操作程序。
Objective To explore the clinical result of fixation on the distal femur and/or proximal tibia with LISS （Less Invasive Stabilization System）, and to analyze the related factors during the operation. Methods From July 2003 to March 2005, 16 patients（17 fractures） were treated with LISS （Mathys, Swiss）. There were 11 males and 5 females, with an average age of 39 years （mean, 19-58 years）, including 9 distal femoral fractures and 8 proximal tibial fractures, while 1 patient sustaining distal femoral and proximal fibial fracture on the ipsilateral side. The LISS plates were inserted beneath the periosteum through a small incision after closed reduction（except the intraartieular fractures）. The locking screws were inserted through stab incisions, and by monocortical fixation. Only 1 patient underwent the bone graft who accepted the open reduction 21 clays after injury. Results All the patients achieved bone union during the follow up from 5 to 25 months （ mean, 15 months ）. 3 patients had their implants removed. The function of the knee was evaluated according to Karlstroem score system based on both the subjective feeling and objective PE, and there were 10 excellent and 3 good, and 3 fair, the good-excellent rate was 81%. Secondary reduction loss occurred in one patient, but bone union and the function of the knee were not compromised. There was also neither infection nor implant pull-out and breakage. Conclusion The unique designed LISS has the advantages of protecting the blood supply of bone fragments and the periosteum, optimizing bone union and function recovery. LISS provides an alternative for treatment of distal femoral or proximal tibial fractures. However, as a new designed system, not only conception but the procedure as well should be demanded strictly.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第4期243-246,共4页
Chinese Journal of Orthopaedics
关键词
股骨骨折
胫骨骨折
骨折固定术
内
治疗结果
Femoral fractures
Tibial fractures
Fracture fixation, internal
Treatment outcome
