锁定钢板置入治疗骨折:25例并发症分析(英文)

Locking plates in treating fractures:Analysis of complications in 25 cases

背景:锁定钢板独特的钉孔和螺钉设计使其在骨折固定过程中可以利用完全不同的固定机制,给骨折的愈合提供不同的生物学环境,引起不同的骨折愈合模式。目的:锁定钢板治疗骨折后出现并发症的25例回顾性分析。方法:对患者体检结果,其受伤机制、是否多发损伤、内固定物选择、操作方法、术后开始负重时间及术后复查的X射线片逐一进行分析。主要观察内固定物失效、骨折不愈合及延迟愈合例数及原因。结果与结论:8例内固定物失效的病例中,4例由于手术操作失误,1例由于内固定物选择失误,1例由于术后负重过早,2例由于术后感染导致内固定物失效;11例骨折不愈合或延迟愈合的患者中,6例由于原始损伤严重,5例由于术中复位不佳引起不愈合或延迟愈合。2例LISS钢板近端突起于皮下引起疼痛,1例术后伤口感染,钢板近端长期外露,是由于术中钢板的放置位置不良。应用锁定钢板固定系统治疗骨折成功的关键是操作者充分理解AO内固定原理,掌握AO内固定技术,强调术中对骨折的良好复位和微创操作。只有良好的术前计划、选择适当病例,正确使用锁定钢板,才能提高骨折愈合率,避免并发症的发生。

BACKGROUND：The unique design of nail hole and screw of locking plate makes it possible to provide different fixation mechanisms in fracture fixation,which can provide diverse biological environments for bone healing,thus,lead to various healing patterns.OBJECTIVE：To retrospectively analyze complications of locking plate treatment for fractures in 25 cases.METHODS：The physical examination results,including injury mechanisms,whether multiple injuries,selection of internal fixation,operation principles,postoperative loading time,and X-ray films recheck,were analyzed subsequently.The numbers and reasons for internal fixation failure,bone nonunion or delayed union were investigated.RESULTS AND CONCLUSION：Among the 8 cases of internal fixation collapse,4 were caused by operation lapses,1 was due to wrong selection of the internal fixation tool,1 case took place by weight bearing too early,2 cases were caused by postoperative infections;Among 11 cases of nonunion or delayed union,6 were caused by severe primary injuries,and 5 by unsuccessful reduction.2 cases of pain stemmed from hypodermal projection of proximal tibia LISS plate,1 from postoperative infection.1 case of long term to be exposed of plate end due to improper location of the plate during the operation was also involved.Essentially,locking plate just is a kind of internal fixation plate.Either the compression plate or the bridging plate,or the combination of the two could be applied in locking plate fixation.Through our study,we found that the pathway leading to the success was built upon an accurate cognition and skillful mastery of AO internal fixation technology,as well as the correct choice of the tool combined with the fine reduction and micro-damage operation.