微创内固定系统治疗股骨远端骨折

Treatment of distal femoral fractures with less invasive stabilizing system

目的探讨应用微创内固定系统(LISS)治疗股骨远端骨折疗效,分析术后并发症原因。方法应用LISS技术治疗股骨远端骨折43例。结果患者均获随访,时间6～28(14±2.5)个月。除骨不愈合、接骨板断裂1例外,42例骨折均愈合,愈合时间12～26(14.5±3.2)周。按照Rasmussen骨折复位评分标准:优31例,良9例,中2例,差1例。术后1年HSS膝关节评分57～98(85.5±8.1)分,优29例,良10例,中3例,差1例,优良率90.7%。术后并发症为:膝关节强直1例,骨不愈合、接骨板断裂1例,骨折对位不良2例,接骨板皮下不适2例,骨折部位骨质疏松7例。21例骨折愈合后行接骨板取出,有8例共15枚锁定螺钉取出困难。无感染、皮肤坏死及内固定松动发生。结论LISS为股骨远端骨折提供了一种有效的治疗方法,部分术后并发症与手术技术及LISS有关,手术经验和功能锻炼可降低术后并发症发生率。

Objective To analyze the clinical results and complications of less invasive stabilization system（LISS） in the treatment of distal femoral fractures.Methods 43 cases of distal femoral fractures were treated with LISS.Results The follow-up averaged（14±2.5） months（range 6 to 28 months）.The mean healing time was（14.5±3.2） weeks（range 12 to 26 weeks） except that one case had nonunion and breakage of implants.According to Rasmussen radiological evaluation,the results were excellent in 31 cases,good in 9,fair in 2 and poor in 1.One year postoperatively,the mean HSS knee score was（85.5±8.1）（57 to 98） points with 29 excellent,10 good,3 fair and 1 poor according to HSS scoring system.1 case had knee joint stiffness.1 case had nonunion and breakage of implants.2 cases had malalignment.2 cases had symptomatic hardware irritation.7 cases had osteoporosis in the fracture＇s area.21 patients underwent implants removal after union.There were 8 cases difficult to removal.No deep infection,skin necrosis and loosening was noted.Conclusions The LISS is an effective way for distal femur fractures.Some of the postoperative complications are inherent with LISS and operating technique.The operating experience and function exercise are needed to decrease the rate of postoperative complications.