微创内固定系统治疗膝关节周围骨折的并发症

Complications of LISS in periarticular fractures of the knee joint

目的探讨微创内固定系统（LISS）治疗膝关节周围骨折术中、术后并发症的发生情况，总结预防措施。方法2004年2月至2007年2月对42例（44侧）膝关节周围复杂骨折患者分别应用股骨远端或胫骨近端LISS接骨板固定，回顾出现并发症的种类、发生率及处理结果，分析并发症发生的原因。结果42例患者获20～176周（平均52周）随访。骨性愈合时间12～25周，平均14周。11例患者术中、术后出现并发症，其中2例浅表感染，1例深部感染，2例复位不良，2例骨折再移位，1例内固定失效，1例腓浅神经损伤，1例骨筋膜室综合征，1例伸膝装置粘连。无骨不连、内固定激惹及内固定取出困难等发生。结论LISS治疗膝关节周围骨折术中、术后并发症的发生与肢体损伤的严重程度、术者对LISS技术的理解程度及操作的熟练程度等有关。

Objective To investigate the complications following the treatment of distal femoral supracondylar fractures and proximal tibial fractures with less invasive stabilization system （LISS） . Methods Forty-two adult patients with complex periarticular fractures of the knee joint were treated with LISS between February 2004 and February 2007. All the cases were followed up for 20 to 176 weeks （averaging 52 weeks） . A retrospective study was done to analyze the incidence, sorts, causes, and managements of their complications that occurred after LISS fixation. Results Thirty fractures （71% ） healed without any complications. Superficial wound dehiscence of less than 1 cm occurred in 2 cases that healed after dressing changes. One was complicated by a deep infection and had partial wound breakdown with direct plate or bone exposure. Two fractures healed in a malaligned position. The postoperative radiographs showed that 2 unstable comminuted type C intraartieular fractures lost alignment before healing. Other complications included postoperative superficial peroneal nerve palsy, significant knee stiffness, breakage of hardware, and postoperative compartment syndrome, each in 1 case. Conclusion A sound knowledge of the operative technique and careful preoperative planning for LISS represents an excellent result and reduce incidence rate of complications.