LISS治疗股骨远端不稳定骨折的并发症分析

Complication of the less invasive stabilization system for mechanically unstable fractures of the distal femur

目的探讨使用微创内固定系统治疗股骨远端不稳定骨折的临床疗效和并发症。方法收集自2011年9月至2014年7月81例应用LISS治疗不稳定性股骨远端骨折病历资料，根据纳入与排除标准，最终59例纳入本研究，其中男31例，女28例；年龄18-80岁，平均49．8岁；左侧40例，右侧19例。根据AO分型，33A2型27例，33A3型14例，33C2型13例，33C3型5例。2例伴有同侧股骨干骨折，其中32A1型1例，32C1型1例。致伤原因：高处坠落伤8例，交通事故伤18例，重物砸伤7例，摔伤26例。闭合骨折55例，开放骨折4例，根据Gustilo和Anderson分型，Ⅰ型3例，Ⅱ型1例。结果59例应用7孔钢板21例，9孔钢板26例，13孔钢板12例；11例在LISS钢板以外加用直径6．5mm或3．5mm的拉力螺钉固定累及关节面的骨折块；手术时间85-145min，平均105．2min；术中出血量130-315ml，平均203ml。59例均获得随访，随访时间为11-27个月，平均13．2个月；骨折愈合时间12-21周，平均为16周，其中1例延迟愈合（13个月）；所有病例均未行一期植骨。59例膝关节功能：膝关节屈曲平均116°，伸直平均0°；膝关节功能为优32例，良19例，可8例，优良率为86．4％。所有患者无深部感染和复位丢失发生，4例出现钢板刺激症状，3例出现对位不良，2例内固定失败，4例共计9枚螺钉出现冷焊接现象致内固定取出困难。结论LISS是治疗股骨远端不稳定骨折有效而可靠的方法之一，但在临床应用中要严格掌握手术指征及操作规范。

Objective To investigate the results and complications in the treatment of the mechanically unstable frac- tures of the distal femur when Less Invasive Stabilization System （LISS） is used. Methods From September 2011 to July 2014, 81 patients with mechanically unstable fractures of the distal femur were treated with the LISS, according to the inclusion criteria and exclusion criteria, 59 patients meet the condition including 31 male and 28 female. The mean age of the patients was 49.8 years （range 18-80 years）. The fractures occurred on the left side in 40 cases and on the right side in 19 cases. According to AO classification, 27 type 33A2, 14 type 33A3, 13 type 33C2, 5 type 33C3.2 cases combined with ipsilateral fractures of the femoral shaft, according to AO classification, 1 type 32A1, 1 type 32C1. The mechanism of injury was a fall from the height in 8 cases, a traffic accident in 18 cases, a crush injury in 7 cases, a fall injury in 26 cases. 55 fractures were closed, and 4 were open. Accord- ing to the Gustilo-Anderson classification, there were 3 type I, 1 type II. Results The 7-hole plate were used in 21 patients, 9- hole plate in 26 patients and 13-hole plate in 12 cases. The 3.5 mm or 6.5 mm lag screw were placed around the LISS plate to sta- bilized the articular fracture fragment in 11 cases. The mean operation time was 105.2 min （85-145 min）, the mean bleeding vol- ume was 203 ml （130-315 ml）. All patients were followed up 11-27 months （average 13.2 months）. 1 delayed union（13 months）, the average time to union was 16 weeks （range 12-21 weeks）. The average flexion of the knee was 116 degree, 0 degree in exten- sion. The functional outcome： 32 had an excellent result, 19 had a good result and 8 had a fair result, with 86.4% excellent and good results. No deep infections occurred. No loss of reduction. 3 cases had malalignment, 2 failed fixation, 4 patients with symp- tomatic hardware irritation. 27 cases underwent implants removal after union, cold-welding occurred in 4 cases （9 screws） which re- suited in difficuh removal. Conclusion LISS is one of the reliable and effective methods in fixation of mechanically unstable fractures of the distal femur. However, its operation indications and operating instructions should be strictly followed.