微创内固定系统在膝部骨折的应用

Discussion of Less Invasive Stabilization System Application in the Fracture around the Knee Joint

目的探讨AO微创内固定系统（less invasive stabilization system，LISS）在膝部骨折（股骨远端和胫骨近端）的应用技术。方法我院自2004年3月至2007年1月治疗膝部股骨远端（14例）和胫骨近端骨折（19例），男20例，女13例；年龄26-89岁，平均41．5岁。其中骨质疏松性骨折13例。开放性骨折4例，分别用股骨远端、胫骨近端微创内固定系统固定股骨远端和胫骨近端。开放骨折依据不同程度，采用Ⅰ期或早期外固定架制动或牵引，在确认无感染和软组织修复后行内固定3例。采用微创侵入钢板接骨技术治疗32例，切开复位内固定1例。结果所有病例随访13～18个月，平均15．6个月，骨折均愈合，无内固定失效，7例因骨缺损植骨，4例复位不良，1例在钢板端发生再骨折，5例取钉困难，3例有切口浅层感染，延长抗生素用药时间10～14d，均正常愈合。膝关节功能采用Lysholm方法评价，优27例，良3例，中2例，差1例，优良率为90．9％。结论LISS治疗膝部骨折是符合生物性固定原则的方法，特别是对常规方法难以处理的骨折，但使用时依据骨折部位和类型需采用不同的对策。

Objective The approach of application of technology of Less Invasive Stabilization System. （LISS）was performed in the treatment of the fracture around the knee joint（distal femur and proximal tibia）. Methods The fracture around the knee joint（distal femur in 14 cases, 19 cases of proximal tibia）were treated in our hospital from March 2004 to January 2007,including 20 cases of male and female 13 cases, the age from 26 to 89 years old （mean 41.5 years old）. There were 13 cases of osteoporotic fracture and 5 cases of open fracture in total and the LISS was used in distal femur（LISS-DF）and proximal tibia（LISS-PLT）. 3 cases open fractures were performed internal fixation after affirmance of no infection and soft tissue repair or early external fixator brake or traction in the early. Invasive internal fixation of minimally mvasive techniques（MIPO） were made in 32 cases ,and open reduction and internal fixation made in 1 case. Results All patients were followed up for 13 months-18 months （mean follow-up 15.6 months） ,and all fractures were healed ,no off nails,broken nails ,broken boards and internal fixation failure. Bone graftings were made in 7 cases of bone defect and there were 4 cases of bad reduction, 1 case occurred again in the end plate fractures, 5 cases of nail removed difficulties.shallow incision had infection in 3 cases and healed by applying antibiotic medication to extend the time for 10-14 days. Lysholm knee function score was excellent 27 cases,good 3 cases ,moderate 2 cases and 1 bad case.and excellent rate was 90.9 percent. Conclusion The less invasive stabilization system（LISS） in the treatmenr of the fracture around the knee joint is in line with the principles of biological fixation,especially in dealing with conventional methods of fracture difficultly.but different opnons should be adopted based on fracture site and type.