微创内固定系统在膝关节周围复杂骨折治疗中的应用

Application of the Less Invasive Stabilization System in complex fractures around the knee joint

目的探讨AO微创内固定系统（less invasive stabilization system，LISS）治疗膝关节周围复杂骨折的效果。方法2004年4月～2005年6月对15例干骺端闭合性膝关节周围复杂骨折（左侧9例，右侧6例），分别应用股骨远端LISS或胫骨近端LISS行内固定治疗。结果15例随访5～26个月，平均13．2月。完全负重时间为12～26周，X线骨愈合时间11～24周，无延迟愈合及骨不连。浅表感染1例，皮肤水疱2例，经换药后愈合。无深部感染及皮肤坏死，无骨筋膜室综合征。Johner-Wruhs方法评价功能优11例、良3例、中1例，以优良为满意标准，本组满意率为93．3％（14／15）。1例C3型胫骨平台骨折在术后2周出现胫骨内侧骨块明显移位伴髁间分离，二次手术在胫骨平台内侧加以支撑钢板固定，术后20周骨折愈合，功能评价为良；1例C3型胫骨平台骨折在术后8周出现膝内翻（胫骨平台内翻角为82°），术后20周骨折愈合，功能评价为中。结论LISS适用于单处股骨远端、胫骨近端骨折及骨质疏松性股骨干远端骨折的治疗；对于胫骨平台C3型骨折内侧平台粉碎严重时，不能过分依赖LISS系统，或将接骨板置于内侧，而应该考虑在内侧辅助支撑钢板。

Objective To discuss curative effects of the AO Less Invasive Stabilization System （LISS） in the treatment of complex fractures around the knee joint. Methods The internal fixation at distal femur or proximal tibia was performed in 15 cases of closed complex fractures at the metaphysic area near the knee joint by using the LISS （left-sided in 9 cases and right-sided in 6 cases） from April 2004 to June 2005. Results All the 15 cases were followed for 5～26 months （mean, 13.2 months）. The time to full weight bearing was 12～26 weeks, and the time to bone union under X-ray was 11～24 weeks. No delayed union or disunion was observed. There were 1 case of superficial infection and 2 cases of skin blister, all of which were cured with dressing changes. No deep infection, skin necrosis, or osteofascial compartment syndrome occurred. Functional evaluation according to the Johner-Wruhs system revealed ＂excellent＂ results in 11 cases, ＂good＂ results in 3, and ＂fair＂ in 1, the total satisfactory rate being 93.3% （14/15）. Palpable shift and separation inside tibia had occurred in 1 case of tibial plateau fracture （type C3） 2 weeks after operation, and a steel bar was inserted to fix the tibial plateau in a second operation. Bone union was achieved in this case 20 weeks after operation, with ＂good＂ evaluation results. Genu varum （tibial plateau angle, 82°） had occurred in 1 case of tibial plateau fracture （type C3） 8 weeks after operation, and bone union was noted 20 weeks after operation, with ＂fair＂ evaluation results. Conclusions The LISS is indicated for fractures at distal femur or proximal tibia, or osteoporotic fractures of distal femoral shaft. For type C3 complex tibial plateau fracture, fixation with a steel bar on the entocondyle should be employed, rather than relying on the LISS.