应用微创内固定系统治疗胫骨近端骨折

Less invasive stabilization system for high-energy fractures of proximal tibia

目的总结应用微创内固定系统(LISS)治疗胫骨近端骨折的临床经验,讨论应用指征及手术技巧。方法分析2003年11月～2004年6月间应用LISS治疗的22例高能量胫骨近端骨折,其中男16例,女6例,平均年龄41.8岁(22～69岁)。按AO分型:41-A型7例,41-C型15例。其中9例合并其它骨折,5例为开放性骨折(GustiloⅢA3例,ⅢB2例)。结果平均随访15个月(12～17个月)。22例完全愈合;2例发生浅表感染,经保守治疗痊愈;患者完全负重时间15.2周(12～18周);X线愈合时间14.5周11～17周)。1例术后6个月随访出现关节面复位丢失,无固定失效及力线不正;关节活动度平(均为2°(0°～15°～98.6°(60°～120°;按照Johner-Wruhs胫骨骨折临床疗效评价法,术后6个月功能优))13例,良7例,中2例,差0例,优良率为90.9%。结论LISS治疗胫骨近端骨折,特别是干骺端粉碎的骨折具有较好的力学稳定性,骨折愈合率高,软组织损伤小,并发症发生率低,是一种有效的治疗手段。但作为新型的固定系统其有特殊的手术技巧及指征,临床应用时应充分理解。

Objective To report the preliminary. results of Less Invasive Stabilization System （LISS） applied in treatment of proximal tibial fractures. Methods 22 patients with acute fractures of proximal tibia were treated with LISS plates frorm November. 2003 to June. 2004. There were 6 females and 16 males, with a mean age of 41.8 years （ranging from 22 to 69 years）. According to AO classification. 7 cases were type 41-A, and 15 cases were type 41-C （9 combined with other fractures） . 5 of these were open fractures （3 cases of Gustilo-Auderson type Ⅲ A aud 2 cases of type Ⅲ B）. Results All fractures were eventually healed. There were 2 cases of superficial infection. No deep infection, failure of fixation or malalignment was found in this group. However. 1 case showed displacement of articular surface 6 months postoperatively. The range of motion was front 2° to 98.6°. The mean time of radiographic healing was 14.5 weeks （ranging from 11 to 17 weeks） and the mean time of full weight bearing was 15. 2 weeks （ranging front 12 to 18 weeks）. By Johner -Wruhs＇ evaluation. 13 cases were rated as excellent. 7 as good, 2 as fair 1 year postuperatively. Conclusions LISS is a safe and effective fixation device for proximal tibial fractures, especially for those caused by high-energy injuries. The benefits of this system include less intervention of blood supply, less soft tissue complications and a high union ratio of fractures.