微创LISS钢板治疗股骨远端及胫骨近端粉碎性骨折
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摘要
目的:探讨微创稳定系统(Less invasive stabilization system,LISS)手术治疗股骨远端及胫骨近端粉碎性骨折的疗效。方法:自2004年3月至2008年1月,我院应用AO系统LISS钢板治疗11例11处骨折。男9例,女2例;平均年龄41岁(32～49岁)。股骨远端粉碎性骨折9处,胫骨近端粉碎性骨折2例。手术采用间接复位,微创切口,经骨膜外与肌肉间插入钢板,经皮小切口将带锁定头的螺钉与钢板的螺孔单皮质固定。术中均未植骨。结果:术后平均随访10个月(3～23月),骨折大部分愈合。3例患者内固定已经取出。膝关节功能按患者主观感受及客观检查结果以HSS评分法进行评估。优5例,良5例,差1例。优良率90.9%。其中1例因术后4个月螺钉断裂行二次手术评定为差。所有病例无植骨及感染发生。结论:LISS钢板设计独特,可保护骨膜及骨折部位的血运,促进骨折愈合和功能恢复。LISS所具备的生物学接骨特性成为股骨远端、胫骨近端粉碎性骨折新的治疗方法。对临床治疗提供了新的选择。
Objective To explore the clinical result of fixation on the distal femur and/or proximal tibia fracture with LISS (Less Invasive Stabilization System), and to analyze the related factors during the operation. Methods From Mar. 2004 to Jan. 2008, 11 patients(11 fractures) were treated with LISS .There were 9 males and 2 females, with age from32 to 49 years (mean, 41 years), including 9 distal femoral fractures and 2 proximal tibial fractures. The LISS plates were inserted beneath the periosteum through a small incision after closed reduction(except the intraarticular fractures). The locking screws were inserted through stab incisions, and by monocortical fixation. No patient underwent the bone graft. Results Almost all the patients achieved bone union during the follow up from 3 to 23 months ( mean, 10 months ). 3 patients had their implants removed. The function of the knee was evaluated according to HSS score system based on both the subjective feeling and objective PE, and there were 5 excellent and 5 good, and 1 poor, the good- excellent rate was 90.9%. Secondary reduction loss occurred in one patient, but bone union and the function of the knee were not compromised. There was no infection in all of the patients. 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.
Objective To explore the clinical result of fixation on the distal femur and/or proximal tibia fracture with LISS (Less Invasive Stabilization System), and to analyze the related factors during the operation. Methods From Mar. 2004 to Jan. 2008, 11 patients(11 fractures) were treated with LISS .There were 9 males and 2 females, with age from32 to 49 years (mean, 41 years), including 9 distal femoral fractures and 2 proximal tibial fractures. The LISS plates were inserted beneath the periosteum through a small incision after closed reduction(except the intraarticular fractures). The locking screws were inserted through stab incisions, and by monocortical fixation. No patient underwent the bone graft. Results Almost all the patients achieved bone union during the follow up from 3 to 23 months ( mean, 10 months ). 3 patients had their implants removed. The function of the knee was evaluated according to HSS score system based on both the subjective feeling and objective PE, and there were 5 excellent and 5 good, and 1 poor, the good- excellent rate was 90.9%. Secondary reduction loss occurred in one patient, but bone union and the function of the knee were not compromised. There was no infection in all of the patients. 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.
引文
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[7] Brumback RJ. The raionales of interlocking nailing of the femur, tibial and humerus[J]. Clin Orthop. 1996,(324):292-320.
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[10]卢永春,谢波,刘文玲,等.动力髁钉板治疗股骨髁间骨折[J].中国骨与关节损伤杂志,2005,20(1) :60-61.
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[14] Markmiller M, Konrad G, Sudkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications[J]? Clin Orthop Relat Res,2004 ,(426): 252-257.
[15] Cole PA, Zlowodzki M, Kregor PJ. Less invasive stabilization system (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminaryresults of the UMC clinical trial[J]. Injury. 2003,34(Suppl. 1):A16–29.
[16] Schutz M, Kaab MJ, Haas N. Stabilization of proximal tibial fractures with the LISS-System: early clinical experience in Berlin[J]. Injury. 2003, 34 ( Supp l 1) : A30-35.
[17] Schutz M, Muller M, Krettec C, et al. Minimally invasive fracture stabilization of distal femoral fractures with the LISS: A perspective multicenter study. Results of a clinical study with special emphasis on difficult cases[J]. Injury, 2001, 32 ( Suppl 3) : 48-54.
[18] Wong MK, Leung F , Chow SP , et al . Treatment of distal femoral fractures in the elderly using a less invasive plating technique[J]. Int Orthop , 2005 ,29 (2) :l17-120.
[19] Button G, Wolinsky P, Hak D. Failure of he less invasive stabilization system plates in the distal femur: a report of four cases[J]. J Orthop Trauma,2007,21:83-91.
[20] O' toole RV, Gobezie R, Hwang R, et al. Low Complication Rate of LISS for Femur Fractures Adjacent to Stable Hip or Knee Arthroplasty[J]. Clin Orthop Relat Res,2006, 450:203-210.
[21]林博文,肖德明,黎伟凡,等.微创经皮钢板固定治疗胫骨骨折[J].中华创伤杂志,2002,18(9):551-553.
[22]马维虎,徐荣明,冯建翔,等.微侵袭钢板技术在膝关节周围骨折的应用[J].中华创伤杂志,2003,19(12):754-755.
[23]刘璠,茹江英,顾永强,等.微创内固定系统治疗复杂性膝关节周围骨折的近期疗效[J].中华创伤骨科杂志,2005,7(11):1015-1020.
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