LISS钢板治疗膝关节周围严重粉碎性骨折疗效观察

LISS plate for treatment of severe comminuted fractures around the knee Efficacy

目的：探讨AO微创内固定系统（less invasive stabilization system，LISS）治疗膝关节周围严重粉碎性骨折的手术适应证及其疗效。方法2009年3月—2012年10月应用LISS钢板治疗膝关节周围严重粉碎性骨折23例，其中股骨骨折13例，胫骨骨折10例。合并髌骨骨折2例，伴其他部位骨折4例。按AO/OTA分型，股骨骨折中，33-A3型3例，33-C2型6例，33-C3型4例；胫骨骨折中，41-A3型3例，41-B2型4例，41-C2型3例。手术采用间接复位（关节内骨折除外），微创切口，经骨膜外和肌肉之间插入钢板，经皮小切口将带锁定头的螺钉与钢板的螺孔锁定。结果全部病例均获得随访，平均时间为15个月（12个月~24个月）。术后伤口均Ⅰ期愈合，1例骨延迟愈合。HSS评分：优17例，良3例，可2例，差1例，优良率86.9%。结论 LISS钢板治疗膝关节周围严重粉碎性骨折具有微创、固定可靠、术后恢复快和骨折愈合快的优点，是理想的内固定材料。明确手术适应证，严格掌握操作程序和重视对骨缺损的处理是取得满意疗效的关键。

Objective To investigate the AO Less Invasive Stabilization System （less invasive stabilization system, LISS） treatment of severe comminuted fractures around the knee and the efficacy of surgical indications. Method In March 2009-2012 years, in October applied around the LISS plate for treatment of severe comminuted fracture of the knee in 23 cases, including 13 cases of femoral fractures, tibial fractures in 10 cases. Combined patella fracture in 2 cases, with other parts of the fracture in 4 cases. According to AO/OTA classification, femur fractures , 33-A3 type 3 cases ,33-C2-type 6 cases ,33-C3 type 4 cases;tibial fractures ,41-A3 type 3 cases ,41-B2 type 4 cases, 41-C2-type 3 case. Use of indirect reduction surgery,Chong-dimensional incision, the periosteum and the muscles inserted between the outer steel plate,a small incision through the skin will take locking head screws with locking screw plate. Results All patients were followed up,with an average time of 15 months （12 to 24 months）. Wound healed, and 1 case of delayed union of bone. HSS score：excellent in 17 cases, good in 3 cases, 2 case and poor in 1 case, good rate of 86.9%.Conclusion LISS plate for the treatment of severe comminuted around the knee with a minimally invasive,reliable fixation,postoperative recovery was quick and fast fracture healing advantages of the treatment of severe comminuted fractures around the knee the ideal fixation materials. Clear hand Surgery indications , strict control procedures and attention to the treatment of bone defects is the key to satisfactory effect.