LISS治疗胫骨近端骨折的并发症

Complications of proximal tibia fractures treated with the less invasive stabilization system

目的分析使用AO微创内固定系统（less invasive stabilization system，LISS）治疗胫骨近端骨折的并发症。方法应用LISS治疗45例46侧胫骨近端骨折，男35例，女10例；年龄22-73岁，平均45岁；左28侧，右18侧。高处坠落伤5例，交通事故伤32例，重物砸伤8例。46侧骨折根据AO分类，41A2型4侧、41A3型12侧、41C1型5侧、41C2型19侧、41C3型6侧。9例患者伴有同侧胫骨干骨折，42A3型1例、4282型4例、4283型3例、42C3型1例。闭合骨折41侧；开放骨折5侧，根据Gustilo和Anderson分类，Ⅰ型2侧、Ⅱ型3侧。结果所有病例均获得随访，随访时间为6-25个月，平均11.4个月。所有骨折均愈合，未经额外植骨，无深部感染发生。平均愈合时间为16周，膝关节屈曲平均112°，伸直平均-1°。并发症发生率为41．6％，4例（9％）骨折对位不良，1例断端向前成角15°、2例向内成角10°、1例外旋15°畸形。2例（4.3％）骨折术后复位丢失，胫骨平台内翻、塌陷。6侧肢体（13％）出现胫骨近端钢板刺激症状，其中有2侧出现迟发的皮肤软组织全层裂开，行局部胫前肌肌皮瓣转移，伤口愈合。腓浅神经与腓深神经损伤各1例（4.3％），经复查症状改善。9例患者在骨折愈合后行钢板取出，有5例（11％）共5枚螺钉出现“冷焊接现象”（cold—welding）致内固定取出困难。结论LISS是一种固定胫骨近端骨折有效且可靠的方法。使用过程中需要术者具备精湛的技术和丰富的经验以减少并发症的发生；另外，某些并发症的出现与器械自身因素有关。

Objective To analize the complications in the treatment of the proximal tibial fractures using Less Invasive Stabilization System （LISS）. Methods 45 patients with 46 fractures of proximal tibia were treated with the LISS. There were 10 females and 35 males. The mean age of the patients was 45 years （range from 22 to 73 years）. The mechanism of injury included fall-down in 5 patients, traffic accident in 32 patients, hit injury in 8 patients. According to AO classification, there were 4 cases in type 41A2, 12 in type 41A3, 5 in type 41C1, 19 in type 41C2, 6 in type 41C3.9 of them combined with ipsilateral fractures of the tibial shaft, and amone them, l case in type 42A3, 4 in type 42B2, 3 in type 42B3, 1 in type 42C3 according to AO classification. 41 cases were closed fractures, and 5 were open. According to the Gustilo-Anderson classification, there were 2 cases in type Ⅰ, 3 in type Ⅱ. Results All patients were followed up 6 to 25 months. All fractures healed without additional bone graft. No deep infections occurred. The average time to union was 16 weeks, the average flexion of the knee was 112 degree, 1 degree in extension absence. The complication rate was 41.6%. 4 cases （9%） had malalignment. 2 eases （4.3%） had loss of reduction, they healed in collapse of medial condyle. There were 6 patients （13%） with symptomatic hardware irritation, 2 （4.3%） of them had soft-tissue breakdown, skin-muscular flap graft were applied. 1 superficial peroneal nerve injury and 1 profound peroneal nerve injury occurred respectively, the symptom improved afterwards. 9 patients underwent implants removal after union, cold-welding occurred in 5 cases （11%） which resulted in difficult removal. Conclusion LISS is one of the reliable and effective methods in fixation of proximal tibial fractures. The technique and experience are needed to decrease the rate of complications, in addition, some of the complications are inherent with LISS.