微创稳定系统（LISS）和解剖钢板治疗股骨远端复杂骨折的对比研究

Comparative study of less invasive stabilization system and anatomical plate for the treatment of the complicated distal femoral fractures

目的对比微创稳定系统（LISS）和解剖钢板治疗股骨远端复杂骨折的临床效果。方法2002年7月至2007年12月，应用LISS及解剖钢板治疗股骨远端复杂骨折42例。解剖钢板组23例，男16例，女7例；年龄21-63岁，平均39．9岁；骨折按AO／OTA分型：A2型3例，A3型7例，C2型12例，C3型l例。LISS钢板组19例，男11例，女8例；年龄20-59岁，平均40．5岁；骨折按AO／OTA分型：A2型2例，A3型6例，C2型10例，C3型1例。比较两组手术时间、手术切口、出血量、是否植骨、术后并发症及愈合时间等，用改良HSS评分来评价术后膝关节功能的改善程度。结果术后解剖钢板组随访12-18个月，平均13．7个月；LISS钢板组随访12-18个月，平均13．8个月。所有患者切口均一期愈合。放射学愈合时间及术后并发症发生总数两组比较差异无统计学意义。解剖钢板组的植骨例数多于LISS钢板组。手术时间、手术切口、出血量及HSS评分比较，LISS钢板组优于解剖钢板组，但LISS钢板组钢板刺激症状有增高的趋势。结论LISS及解剖钢板治疗股骨远端复杂骨折均可取得满意效果，但LISS固定系统具备角度稳定性，骨折固定可靠，体现微创原则，是治疗股骨远端复杂骨折的新趋势。

Objective To conclude the clinic outcomes of the treatment of the complicated distal femoral fractures with less invasive stabilization system （LISS） and anatomical plate. Methods From July 2002 to December 2007, 42 patients with complicated distal femoral fractures were treated with LISS or anatomical plate （16 males, 7 females, with the average age of 39.9 years）. AO/OTA types were involved with A2, A3, C2, and C3. The patients in LISS group were treated with locked plate （LISS）, and the patients in anatomical plates group were reduced via the incision and treated with anatomical plates. All patients were followed for 12 to 18 months. Outcomes were assessed by recording the surgical experience, post-operative complications and improvements of knee function as measured by the modified HSS score. Results For all patients, there were no differences in the mechanisms of injury, fracture type, mean age, gender distribution between the two groups. The surgical time, wound size and blood loss were significantly less in the LISS group than those in the anatomical plate group. The bone graft was used more frequently in the anatomical plate group. Overall post-operative complications, bony union rate or radiographic healing times were all sim- ilar in both groups. A significantly higher incidence of post-operative loss of reduction was observed in the anatomical plate group. A trend toward significance of a higher incidence of symptomatic hardware irritation was observed in the LISS group compared to the anatomical plate group. Conclusion LISS and the anatom- ical plate both obtain the satisfactory outcomes in our study. Less invasive stabilization system has angel sta- bility, and is a safe and effective for complicated fractures of distal femoral fractures. LISS provides an alter- native treatment for the complicated distal femoral fractures, and is new trend.