微创内固定系统治疗复杂性膝关节周围骨折的近期疗效

Short-term results of treatment of complex fractures of distal femur and proximal tibia with less invasive stabilization system

目的评价微创内固定系统(LISS)治疗股骨远端和胫骨近端严重粉碎性骨折的近期疗效。方法自2004年2月～2005年2月应用LISS治疗63例复杂性膝关节周围骨折,其中股骨远端粉碎性骨折29例,胫骨近端粉碎性骨折34例,手术均严格按照LISS操作程序进行。术后4周内每周随访1次,以后每月随访一次。结果所有患者均获得随访,平均随访11.5个月(6～17个月)。所有患者术后均无需石膏外固定,第1天始渐进膝关节主、被动功能训练,完全负重时间为14.3周(11～17周)。A、C型骨折术后4周膝关节平均活动范围分别为113°(90°～140°)和101°(60°～130°)。X线所见:52例(82.5%)于术后3周左右可见骨痂形成,骨折愈合时间平均为12.1周(10～14周),63例中57例术后骨折对线满意,6例出现成角畸形,其中4例在矢状面上成角10°,2例在冠状面上成角9°。全组无感染、延迟愈合、断钉、断钢板等并发症。手术时间平均为45min(30～60min),切口长度平均为5.5cm(4～6cm)。按照HSS评分:优47例(74.6%)、良14例(22.2%)、可2例(3.2%)。结论微创内固定系统具有创伤小、骨折愈合快、固定牢靠、可早期功能锻炼等优点,近期疗效满意,该法确系膝关节周围严重粉碎性骨折的最佳疗法之一。

Objective To evaluate the short-term results of treatment of severe comminuted fractures of distal femur and proximal tibia with the less invasive stabilization system （LISS） . Methods From February, 2004 to February, 2005, 63 eases of complex fractures were treated using LISS in our department. There were 29 comminuted fractures of distal femur and 34 comminuted fractures of proximal tibia. All the cases were followed up once a week at the first month,once a month from the second month post-operatively. Results All the cases were followed up for 6 to 17 months （averaging 11.5 months） . Active and passive exercises started at the first day after surgery without casting. The average time of full weight loading was 14. 3 （11 to 17） weeks. In fractures of types A and C, the mean ROM of knee was 113°（90° to 140°） and 101°（60° to 130°） 4 weeks after operation respectively. Callus formation was seen on X-rays about 3 weeks past surgery in 52 cases （82.5%） and the average time of bone union was 12. 1 （10 to 14） weeks. The postoperative alignment of fracture was satisfactory in 57 of the 63 cases, and the angulation was found in 6 cases, in which 4 showed 10° angulation in the sagittal plane and 2 had 9° angulation in the coronal plane. No complications, such as non-union, breakage of plate and screw or deep infection, occurred in all the cases. The mean time of operation was 45 （30 to 60） minutes and the average length of incision was 5.5 （4 to 6） cm. The HSS scores were excellent in 47 cases （74. 6% ）, good in 14 （22.2%）, fair in 2 （3.2%） . Conclusion Since LISS is less invasive, provides solid fixation, promotes bone heeling and permits early functional rehabilitation, it is well suited for the treatment of complex fractures of distal femur and proximal tibia.