股骨远端粉碎骨折应用股骨远端内固定系统手术失败原因分析

Analysis of failure cause for treatment of comminuted fracture of distal femur by LISS-DF

[目的]探讨股骨远端粉碎性骨折行股骨远端微创内固定系统(less invasive stabilization system-distalfemur,LISS-DF)术后发生内固定失败的原因。[方法]自2004年8月～2008年12月应用LISS-DF治疗186例股骨远端粉碎性骨折,按AO/OTA分类:33A3型59例,33C2型71例、33C3型56例。[结果]全部病例平均随访24.5个月(11～37.5个月);最后1次随访时均完成骨性愈合,X线骨愈合时间平均6.1个月(3.5～12.6个月);18例在最后1次随访时发生膝关节僵硬(活动范围:-5°～65°);其余患者膝关节活动屈115°(109°～118°),伸0°。术后13例发生内固定松动、脱出及断裂并发症。患膝按Rasmussen骨折复位标准评分[1],平均17.6分(12～19分),其中优108例,良78例;按照Merchant膝关节功能评分[2]:优98例、良70例、可18例,优良率为90.3%。[结论]术中发生钢板位置漂移、锁钉偏向和螺纹破坏、钢板长度选择不恰当、严重骨缺损而未植骨及术后过早负重可能是股骨远端粉碎性骨折行LISS-DF术后发生内固定失败的主要原因,减少医源性因素和增加患者的医从性是有效避免此类并发症发生并取得满意疗效的关键。

[Objective]To investigate the failure cause for treatment of comminuted fractures of distal femur with the less invasive stabilization system of distal femur （LISS-DF）.[Method]From August 2004 to December 2008,186 cases of comminuted fractures of distal femur were treated with LISS-DF.According to AO/OTA classifications：186 cases of patients included 59 cases of type 33 A3,71 cases of type 33 C2 and 56 cases of type 33 C3.[Result]All patients were followed up for average of 24.5 months （range,11～37.5 months） and all achieved bony union at the last follow-up.The average time of unin was 6.1 months （range,3.5～12.6 months）.The stiffness of knee joint occurred in 18 cases at the last follow-up （range,-5～65°）.ROM of the affected knee of other patients was developed to average 115° flexion （range,109°～118°） and 0°extension.Complications as loosening,prolapse and rupture of internal fixators were found in 13 cases postoperatively.According to Merchant score system for knee joint,90.3% of patients achieved excellent healing（98 cases） and good healing（70 cases）.According to Rasmussen criteria of fracture reduction,there were excellent result in 108 cases,good in 78 cases.[Conclusion]The main causes of failure for treatment of comminuted fractures of distal femur with LISS-DF include drift of plate,deviation of LHS,disappropriate length of internal fixators,larger bone loss but non bonegrafting,and postoperatively earlier weight-bearing,so it is a key for avoidance of fixation failure and obtaining of satisfactory effect of treatment to reduce the iatrogenic factors and increase the compliance of patients.