微创锁定加压钢板固定术中失误及术后早期并发症分析

Analysis of intraoperative mistakes and early complications of treatment with minimally invasive locking compression plate(LCP) osteosynthesis

目的分析微创锁定加压钢板固定术中失误及术后早期并发症的原因。方法回顾性分析2006年9月～2011年3月采用微创锁定加压钢板治疗306例四肢骨折。其中男175例,平均年龄42.7岁(14～69岁);女131例,平均年龄43.5岁(17～67岁)。股骨骨折103例,胫骨骨折191例,肱骨骨折10例,尺桡骨骨折2例。结果 35例发生了术中失误或出现术后早期并发症,发生率为11.43%。术中失误包括成角畸形11例,钢板偏心固定5例,重要神经损伤1例,螺钉位置不正2例,螺钉进入关节2例;术后早期并发症包括术后早期感染3例,钢板外露2例,骨折延迟愈合4例,不愈合1例,钢板断裂3例,关节僵硬1例。结论微创锁定加压钢板固定术中失误及术后早期并发症的原因在于此项技术推广应用时间较短,对其理念认识不足,复位固定综合外科技术不全面,康复指导不够。

Objective To analyze the reasons of intraoperative mistakes and early complications of surgical treatment with minimally invasive locking compression plate（LCP） osteosynthesis.Methods From September 2006 to March 2011,306 patients of extremities fractures were treated with minimally invasive locking compression plate（LCP） osteosynthesis.There were 175 males with an average age of 42.7 years（range 14~69 years） and 131 females with an average age of 43.5 years（range17-67 years）.They included 103 cases of femur fractures,191 of tibia,10 of humerus and 2 of radius and ulna.Results 35 mistakes or complications were recorded.The incidence was 11.43%.Intraoperative mistakes in the study included angular deformity in 11 cases,plate eccentric fixation in 5,significant nerve injury in 1,screw malposition in 2 and screw into joint in 2.Postoperative complications included early infection in 3 cases,plate exposure in 2,delayed union in 4,nonunion in 1,plate breakage in 3 and joint stiffness in 1.Conclusion The intraoperative mistakes and early complications may be caused by the shorter application of this technology,the underestimation of its concept,the lack of comprehensive surgical techniques in reduction and fixation and the inadequate guidance of rehabilitation.