双切口微创稳定系统治疗复杂股骨远端骨折疗效评价

TREATMENT EVALUATION OF DISTAL FEMORAL FRACTURE BY LESS INVASIVE STABILIZATION SYSTEM VIA TWO INCISIONS

目的回顾性分析采用微创稳定系统(less invasive stabilization system,LISS)治疗复杂股骨远端骨折患者临床资料,评价其治疗效果。方法2004年3月-2005年11月,收治47例(49侧)股骨髁间、髁上骨折患者。男34例,女13例;年龄19～56岁,平均39.7岁。左侧21例,右侧28例。车祸伤31例,坠落伤8例,暴力打击伤6例,其他伤2例。髁间骨折14侧,髁上骨折21侧,两者合并骨折14侧。根据AO分型:33-A1型6侧,33-A2型8侧,33-A3型10侧,33-C1型7侧,33-C2型3侧,33-C3型15侧。闭合骨折32侧,开放骨折17侧。受伤至入院时间30min～6d。术中先复位固定关节面,利用双切口插入LISS钢板,透视满意后拧入锁定螺钉。结果患者手术时间为48～248min,平均126min。术中出血量为60～1200mL,平均180mL。术后45侧伤口Ⅰ期愈合,余4侧切口感染,对症治疗后愈合。47例患者均获随访12～23个月,平均18.6个月。4侧术中存在前后成角畸形,将LISS取出二次固定后纠正,术后无前后成角畸形。5侧内外翻角度为2～5°,2侧外旋畸形,1例患肢较健侧短缩2cm,均未作特殊处理。无下肢内旋患者,无钢板及螺钉断裂、松动等内植物失败情况发生。43侧骨折于术后3～8个月达临床愈合,平均5.6个月;余6侧经二次自体髂骨植骨后骨折愈合。膝关节Iowa评分:优22例,良19例,中6例,差2例,疗效评价优良率达83.6%。结论采用双切口LISS治疗复杂股骨远端骨折具有一定的优越性。

Objective To evaluate the clinical results of less invasive stabilization system （LISS） for femur supercondylar and intercondylar fractures. Methods From March 2004 to November 2005, 47 patients with 49 intercondylar and supercondylar fractures were treated. Of all the patients, there were 34 males and 13 females with an average of 39.7 years （range 19-56 years）. The locations were left side in 21 cases and right side in 28 cases. Fracture was caused by traffic accident in 31 cases, falling in 8 cases, violence in 6 cases and others in 2 cases. Forty-nine fractures included 14 intercondylar fractures, 21 supercondylar fractures and 14 intercondylar and supercondylar fractures; 32 dosed fractures and 17 open fractures. According to the AO typing, there were 6 type 33-A1, 8 type 33-A2, 10 type 33-A3, 7 type 33-C1, 3 type 33-C2 and 15 type 33-C3. The disease course was 30 minutes to 6 days. Articular surface reduction was first performed, then the LISS plate was inserted via two incisions and locking screws were used later. Results The average operation time was 126 minutes （range 48-248 minutes）. The blood loss was 180 mL（range 60-1 200 mL）. The average follow-up time was 18.6 months （range 12-23 months）. There were 4 patients with AP angular deformity and 5 patients with lateral angular deformity （range 2-5°）. External rotation deformity was presented in 2 patients. There were no plate breakage, screw loosen and fixation failure. Average bone union time was 5.6 months （range 3-8 months） without infection case. Six cases were treated with iliac bone transplantation for delayed union. Conclusion LISS is one kind of effective treatment to femoral intercondylar and supercondylar fractures.