应用锁定钢板治疗骨折后出现并发症的原因分析

Causal analysis of complications after fracture treatment with locked plates

目的增进对锁定钢板的认识，提高应用此类内固定物治疗骨折的临床效果。方法2005年6月至2007年6月对25例应用锁定钢板治疗骨折后出现并发症的病例进行回顾性分析研究。结果8例内固定物失效的病例中，4例由于手术操作失误，1例由于内固定物选择失误，1例由于术后负重过早，2例由于术后感染导致内固定物失效；11例骨折不愈合或延迟愈合的患者中，6例由于原始损伤严重，5例由于术中复位不佳引起不愈合或延迟愈合。2例LISS钢板近端突起于皮下引起疼痛，1例术后伤口感染，钢板近端长期外露，是由于术中钢板的放置位置不良；膝外翻畸形3例。结论锁定钢板可以分别或联合应用两种不同的内固定原理（加压钢板和桥接钢板）对骨折进行固定，应用此类内固定系统治疗骨折成功的关键是充分掌握此内固定物的固定原理，正确选择和应用此内固定物；强调术中对骨折的良好复位和微创操作。

Objective To better our understanding of locked plates in fracture treatment. Methods A retrospective analysis was done to study the causes of the 25 cases of complications following fractural treatment with locked plates who had been admitted to our department from June 2006 to June 2007. Results Of the 8 cases of internal fixation failure, 4 were caused by operative mistakes, 1 by wrong selection of internal fixators, 1 by too early weight-bearing, and 2 by postoperative infection; of the 11 cases of nonunion or delayed union, 6 were caused by severe primary injury, and 5 by unsuccessful reduction. Two cases of pain were caused by evection of proximal LISS plate, and 1 postoperative infection due to improper emplacement of the plate during the operation resulted in long exposure of plate end. Conclusion The successful application of locked plates in fracture treatment lies in a correct understanding and skillful mastery of the principle of locked internal fixators, a proper choice of the tool, fine reduction and mini-invasive operation.