DCS治疗股骨髁上及髁间骨折32例探讨

目的探讨对32例股骨髁上及髁间骨折DCS内固定治疗临床效果。方法按AO分类：33-A1型6例，33-A2型10例，33-A3型4例，33-C1型6例，33-C2型4例，33-C3型2例，经股骨下段外侧切口入路整复骨折，并用DCS固定骨折。结果经1年随访，骨折愈合，平均愈合时间6个月，关节功能优良率93．75％，其中33-C3型骨折1例术后出现膝内翻。结论DCS对股骨髁上及髁间骨折是较理想的内固定物。     

双切口LISS钢板治疗股骨髁间和髁上骨折

目的报道应用LISS钢板治疗股骨髁间和髁上骨折的方法和疗效。方法应用双切口切开复位LISS钢板内固定治疗股骨髁间骨折14例,髁上骨折23例,两者合并骨折8例。结果45例随访8～22个月。所有患者均未出现内植物失败情况。骨折愈合时间为3～9个月。8例出现2～5°的膝内翻或膝外翻;4例出现小于15°的下肢外旋畸形;5例患肢较健侧缩短2 cm。结论采用双切口LISS钢板内固定治疗股骨髁间和髁上骨折,能够取得良好的临床疗效。     

AO微创内固定系统治疗股骨远端骨折

目的 探讨AO微创内固定系统(LISS)治疗股骨远端骨折的临床效果.方法 应用LISS治疗股骨远端骨折15例,33-A2型2例,33-A3型5例,33-C2型5例,33-C3型3例.9例开放骨折为Gustilo Ⅱ～Ⅲ型,其中有4例多发骨折.结果 所有患者随访3～19个月,骨折均连接,骨折愈合时间12(8～18)周.未出现钢板螺钉松动移位、骨折塌陷、复位丢失等.HSS评分:优5例,良7例,可3例.膝关节活动范围70°～140°,所有患者膝关节行走无疼痛.结论 LISS能有效治疗各种分型的股骨远端骨折,特别是对于骨质疏松患者具有更好的优越性.     

微创内固定系统在粉碎性股骨远端骨折中的应用

目的探讨微创内固定系统(less invasive stabilization system,LISS)治疗股骨远端粉碎性骨折的临床疗效。方法自2007年6月至2010年11月应用LISS钢板治疗股骨远端粉碎性骨折36例,其中男29例,女7例;年龄19~67岁,平均42岁。开放性骨折7例,闭合性骨折29例。按AO/OTA分型,33-A2型14例,33-A3型7例,33-C2型9例,33-C3型6例。手术采用间接复位干骺端骨折,(关节内骨折除外),微创切口,经骨膜外和肌肉之间插入钢板,经皮小切口拧入螺钉。结果术后平均随访17.5个月(10~28个月)。平均手术时间80 min(50~145 min)。平均失血量350 mL(200~650 mL)。骨折全部愈合,平均愈合时间为15周(9~60周)。按照HSS评分,优19例(52.8%),良13例(36.1%),可4例(11.1%),优良率88.9%。所有病例无感染,无钢板断裂和螺钉脱出。结论 LISS钢板设计独特,固定牢固,可保护骨膜及骨折部位血运,促进骨折愈合和功能恢复。     

LISS固定系统治疗股骨远端骨折

目的：探讨应用AO微创内固定系统（tass）治疗股骨远端骨折的临床效果。方法：应用LISS治疗股骨远端骨折15例,33-A2骨折2例,33-A3骨折5例,33-C2骨折5例,33-C3骨折3例;其中9例开放骨折均为Ⅱ～Ⅲ级,有4例患者为多发骨折患者,伤后4d（2～7d）应用LISS行内固定治疗。结果：所有患者随访3—19个月,骨折均连接,骨折愈合时间8～18周,未出现钢板螺钉松动移位、骨折塌陷、复位丢失等。股骨远端骨折15例,HSS评分优5例;良7例;可3例。膝关节活动范围70°-140°,所有患者膝关节行走无疼痛。结论：LISS能有效治疗各种分型的股骨远端骨折。     

微创内固定系统治疗复杂股骨转子部骨折的初步报告

目的探讨微创内固定系统(LISS)治疗复杂股骨转子部骨折的可行性、手术技术及指征,并总结其近期临床治疗效果。方法自2005年6月～2006年5月,应用LISS治疗复杂股骨转子部骨折12例。骨折采用AO分类法,其中转子间骨折5例：31-A2．2型2例,31-A2．3型2例,31-A3．3型1例；转子下骨折7例：32-A3．1型1例,32-B1．1型3例,32-B2．1型1例,32-B3．1型2例。记录手术时间、术中出血量、术后住院时间,术后观察有无感染、下肢深静脉血栓、心肺疾患、应激性溃疡等并发症。术后1、2、3、6、12个月时常规随访。结果手术时间50～90 min,平均65 min；出血量50～400 mL,平均142 mL,术后住院时间6～15 d,平均9．3 d。无死亡病例。所有患者均未出现切口感染、下肢深静脉血栓、术后心肺疾患、应激性溃疡等并发症。12例均获得3～14个月(平均7．2个月)随访。10例在术后3个月复查骨折时达到临床愈合,1例假体周围骨折术后4个月、1例病理性骨折术后6个月达到临床愈合。所有患者在最后一次随访时均无骨折再移位、髋内翻畸形、内固定切出、内固定失败及股骨头坏死。结论微创反向使用股骨LISS从生物力学和解剖结构上都能满足股骨近端骨折内固定要求,并具有创伤小、操作简便、固定可靠、安全性高、并发症少的特点,尤其适用于老年人合并内科疾病、骨质疏松较重的转子间骨折及复杂的股骨近端骨折。熟练掌握间接复位技术,正确放置A孔导针,避免过早负重是手术成功的关键。     

股骨髁上髓内钉结合进钉点取骨移植治疗股骨远端骨不连

目的总结股骨髁上髓内钉结合进钉点环锯取骨移植治疗股骨远端骨不连的临床疗效。方法 2002年4月-2010年12月,采用股骨髁上髓内钉结合进钉点环锯取骨移植治疗6例股骨髁上骨不连患者。男4例,女2例;年龄27～74岁,平均40.3岁。原始骨折中开放骨折1例,闭合骨折5例。交通事故伤5例,摔伤1例。按AO分型:32-A1型1例,32-A2型1例,32-C1型1例,33-A3型1例,33-C1型1例,33-C2型1例。术后5～16个月发生内固定物相关并发症后再次手术治疗。其中肥大性骨不连2例,萎缩性骨不连4例;钢板断裂3例,螺钉拔出2例,螺钉断裂1例。结果术后5例患者切口Ⅰ期愈合;1例切口感染,经换药后愈合。6例均获随访,随访时间13～120个月,平均40.3个月。X线片示骨折愈合时间4～8个月,平均5.8个月。术后1年膝关节屈曲80～135°,髋关节屈曲120～140°。结论采用股骨髁上髓内钉结合进钉点环锯取骨移植治疗股骨远端骨不连是一种新尝试,为临床治疗提供了一种选择。     

LISS钢板治疗股骨中下段粉碎性骨折的临床应用体会

目的探讨LISS钢板治疗股骨中下段粉碎性骨折的方法和临床疗效。方法应用LISS钢板对7例股骨远端粉碎性骨折,5例股骨中下段骨折,3例股骨远端骨折伴髁间粉碎性骨折患者采用LISS钢板治疗。结果随访6～24个月,平均10个月。患者骨折全部愈合,愈合时间平均为9个月,所有患者均未出现内植物失败的情况,术后无肢体缩短、膝内翻、膝关节强直等并发症发生。结论 LISS钢板治疗股骨髁间及中下段粉碎性骨折,是一种较好的内固定治疗方法。     

股骨远端骨折微创内固定系统临床应用

目的 探讨应用股骨远端微创内固定系统（less invasive stabilization system—distal femur，LISS—DF）治疗33A3、33C2和33C3型骨折的疗效与影响因素。方法2004年8月～2005年12月，应用LISS—DF治疗26例股骨远端骨折。男15例，女11例；年龄32～72岁，平均55岁。33A3型9例，33C2型11例、33C3型6例。左侧16例，右侧10例。交通伤12例，高处坠落伤9例，压砸伤5例。开放性骨折3例，其中Gustilo Ⅰ型2例，Gustilo ⅡA型1例。受伤至手术时间6h～16d，平均4d。33C2、C3型骨折17例采用髌骨旁外侧切口，结合经关节逆行插入钢板接骨技术插入LISS—DF固定；33A3型骨折9例采用间接复位方法，经皮小切口将自攻或自钻型锁定头螺钉与LISS—DF钢板单皮质锁定。结果术后患者获随访12～26个月，平均14．5个月。1例出现骨延迟愈合，最终达骨性愈合；X线片示骨折愈合时间11～36周，平均16．1周；完全负重时间13～26周，平均17．6周。1例发生切口浅部感染，经换药后愈合；5例因股骨远端外侧严重疼痛于术后6～13个月行内固定物拔除术。均无深部感染、内固定松动、脱出及断裂发生。术后根据Rasmussen骨折复位标准评分12～19分，平均17．6分，其中优16例，良9例，可1例。按照Merchant膝关节功能评分：优13例，良11例，可2例，优良率为92．3％。结论LISS系统设计符合生物学固定原理，对股骨远端A3、C2和C3型骨折提供了一种新的有效内固定方法，但在临床应用中要严格掌握手术指征及操作规程。     

微创内固定系统治疗复杂性膝关节周围骨折的近期疗效

目的评价微创内固定系统(LISS)治疗股骨远端和胫骨近端严重粉碎性骨折的近期疗效。方法自2004年2月～2005年2月应用LISS治疗63例复杂性膝关节周围骨折,其中股骨远端粉碎性骨折29例,胫骨近端粉碎性骨折34例,手术均严格按照LISS操作程序进行。术后4周内每周随访1次,以后每月随访一次。结果所有患者均获得随访,平均随访11.5个月(6～17个月)。所有患者术后均无需石膏外固定,第1天始渐进膝关节主、被动功能训练,完全负重时间为14.3周(11～17周)。A、C型骨折术后4周膝关节平均活动范围分别为113°(90°～140°)和101°(60°～130°)。X线所见:52例(82.5%)于术后3周左右可见骨痂形成,骨折愈合时间平均为12.1周(10～14周),63例中57例术后骨折对线满意,6例出现成角畸形,其中4例在矢状面上成角10°,2例在冠状面上成角9°。全组无感染、延迟愈合、断钉、断钢板等并发症。手术时间平均为45min(30～60min),切口长度平均为5.5cm(4～6cm)。按照HSS评分:优47例(74.6%)、良14例(22.2%)、可2例(3.2%)。结论微创内固定系统具有创伤小、骨折愈合快、固定牢靠、可早期功能锻炼等优点,近期疗效满意,该法确系膝关节周围严重粉碎性骨折的最佳疗法之一。     

AO微创内固定系统治疗胫骨近端骨折

目的：探讨应用AO微创内固定系统（less invasive stabilization system,LISS）治疗胫骨近端骨折的临床效果。方法：2005年6月至2008年6月间,应用LISS治疗胫骨近端骨折32例,41-A2骨折5例,41-A3骨折8例,41-C1骨折7例,41-C2骨折6例,41-C3骨折6例。其中9例开放骨折均为Ⅱ-Ⅲ级,有6例患者为多发骨折患者,伤后4d（2-7d）应用LISS行内固定治疗。结果：所有患者随访6-18个月,骨折均连接,平均骨折愈合时间12周（8-18周）,未出现钢板螺钉松动移位、骨折塌陷、复位丢失等。胫骨近端骨折32例,HSS评分优20例,良14例,可2例。膝关节活动范围90°-140°,所有患者膝关节行走无疼痛。结论：LISS能有效治疗各种分型的胫骨近端骨折,特别是对于骨质疏松患者具有更好的优越性。     

锁定钢板治疗股骨远端骨折的若干问题探讨附八例病例回顾

目的 探讨锁定钢板治疗股骨远端骨折存在的问题。方法 从2007年3月至2010年6月收治的股骨远端新鲜骨折或骨不连患者数据库中选取8例典型患者进行回顾性分析,其中 6例为新鲜骨折,2例为骨不连伴内置物失效。男7例,女1例;年龄37 ～63岁,平均48.5岁。原始骨折按AO分型：32-A1型2例,33-A1型1例,33-A3型1例,33-C2型4例;均为闭合性骨折。6例新鲜骨折患者中,5例采用闭合复位+微创内固定系统(LISS)经皮插入治疗,1例采用开放复位围关节解剖锁定钢板固定;2例骨不连伴内置物失效的患者采用原外侧手术入路切开,取出失效的螺钉和钢板,更换为LISS固定。结果 8例患者术后获平均22.1个月（12 ～ 30个月）随访。锁定钢板固定术后并发症：肥大型骨不连2例,萎缩型骨不连1例,骨折延迟愈合1例,股骨外翻畸形、骨不连1例,深部感染1例。受伤至骨折愈合时间平均为22个月（4 ～ 49个月）。末次随访时膝关节主动活动度为40°～125°,平均81.3°。结论 使用锁定钢板治疗股骨远端骨折时,应充分理解骨折部立和类型,严格掌握锁定钢板固定的原则和指征,否则易出现骨折延迟愈合和骨不连等并发症。     

Distal femoral fractures: long-term outcome following stabilisation with the LISS

We studied 29 patients with distal femoral fractures stabilised using the less invasive stabilisation system (LISS). Four patients were excluded from the final follow-up (three deaths and one case of quadriplegia). The mean age of the remaining 25 patients (9 males and 16 females) was 60.9 years and the mean follow-up 18 months (range 12-24 months). Eleven patients were tertiary referrals from other hospitals (seven cases were referred due to failure of primary fixation). Overall, there were 12 cases of high-energy trauma (7 open fractures). According to the AO classification, there were 5 Type 33A, 2 Type 33B and 12 Type 33C fractures and 4 Type 32A, 1 Type 32B, 1 Type 32C fractures. Functional assessment was performed using the modified Hospital for Special Surgery (HSS) and the Schatzker and Lambert scores. The average time to union in 22 cases was 3.5 months (range 2-5 months). All of the acute cases united without the need for bone grafting. There were three out of seven cases of non-union in the salvage group still undergoing treatment. The overall result in the acute cases was good and in the salvage cases fair. While this is a small series of patients, our preliminary data indicate favourable results using the LISS in stabilising acute distal femoral fractures. However, when the LISS is used as a revision tool the results seem to be less satisfactory. The system appears to be user-friendly and no technical difficulties were encountered.     

Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures

OBJECTIVE: To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients into a database. SETTING: Academic level I trauma center. SUBJECTS/PARTICIPANTS: Eighty-seven consecutive patients with 89 proximal tibia fractures (AO/OTA type 41 and proximal type 42 fractures) treated by 2 surgeons. Seventy-five patients with 77 fractures were followed until union. The mean follow-up was 14 months (range: 3-35 months). There were 55 closed fractures and 22 open fractures. INTERVENTION: Surgical reduction and fixation of fractures, followed by rehabilitation. MAIN OUTCOME MEASUREMENTS: Perioperative and postoperative complications, postoperative alignment, loss of fixation, time to full weight bearing, radiographic union, and range of motion. RESULTS: Seventy of 77 fractures healed without major complications (91%). There were 2 early losses of proximal fixation, 2 nonunions, 2 deep delayed infections, and 1 deep peroneal nerve palsy. Other complications included a superficial wound infection and 3 seromas. Postoperative malalignment occurred in 7 patients with 6 degrees to 10 degrees of angular deformity (6 flexion/extension and 1 varus/valgus malalignments), and an eighth patient had a 15 degrees flexion deformity. In 4 patients, the hardware was removed at an average of 13 months because of irritation (5%). The mean time for allowance of full weight bearing was 12.6 weeks (range: 6-21 weeks), and the mean range of final knee motion was 1 degrees to 122 degrees . CONCLUSIONS: The LISS provides stable fixation (97%), a high rate of union (97%), and a low (4%) rate of infection for proximal tibial fractures. The technique requires the successful use of new and unfamiliar surgical principles to effect an accurate reduction and acceptable rate of malalignment.     

后侧入路内固定治疗胫骨平台后侧骨折

目的 探讨后侧入路内固定治疗胫骨平台后侧骨折的近期疗效.方法 对2008年6月至2010年6月采用后侧入路内固定治疗且随访资料完整的11例胫骨平台后侧骨折患者进行回顾性分析.男7例,女4例;年龄33～60岁,平均47.8岁.AO/OTA分型:41-B2.2.4型2例,41-B3.1.2型3例,41-B3.3.2型3例,41-B3.1.2型+41-B3.3.2型2例,41-C3.3型1例.5例后外侧骨折采用膝关节Carlson后外侧入路;3例后内侧骨折采用Carlson后内侧入路;3例累及胫骨平台前、后侧及胫骨髁间嵴骨折者采用Carlson后内和(或)后外入路,辅以前侧入路行钢板螺钉内固定.关节面塌陷者采用自体髂骨植骨.结果 随访3个月至2年,平均1.6年.全部病例均获得影像学上的骨性愈合,愈合时间12～16周.Rasmussen放射学评分15～18分,平均16.7分.骨折愈合后美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分75～96分,平均86.2分.后外侧入路5例膝关节活动范围平均0°-135°,后内侧入路3例0°-130°,混合入路3例-10°-125°.结论 胫骨平台骨折表现为以后侧为主时,应选择后外或后内侧手术入路,于直视下进行复位及固定,便于操作,术后近期疗效满意.

Abstract：

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.     

微创内固定系统在治疗股骨近端复杂骨折中的应用

目的：探讨应用微创内固定系统（less invasive stabilization system,LISS）治疗股骨近端复杂骨折的疗效和特点。方法：对35例股骨近端复杂骨折做有限切开复位LISS系统内固定治疗。记录手术时间、术后出血量。术后1、3、6、12个月常规拍片随访。结果：手术时间40-80min,平均60min。出血量100-400ml,平均180ml。35例均获3-18个月（平均9．2个月）随访。35例术后3月常规复查均获临床愈合。未出现骨折移位、髋内翻畸形及内固定失败。结论：LISS反向使用治疗股骨近端骨折具有操作简便、手术损伤小、并发症少、固定可靠的优点。     

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures

OBJECTIVE: To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). DESIGN: Retrospective analysis of prospectively enrolled patients. SETTING: Two academic level I trauma centers. SUBJECTS AND PARTICIPANTS: One hundred nineteen consecutive patients with 123 distal femur fractures (OTA type 33 and distal type 32 fractures) treated by 3 surgeons. One hundred three fractures (68 closed fractures and 35 open fractures) in 99 patients were followed up at least until union (mean follow-up = 14 months, range: 3-50 months). INTERVENTION: Surgical reduction and fixation of distal femur fractures. MAIN OUTCOME MEASUREMENTS: Perioperative complications, radiographic union, infection rate, loss of fixation, alignment, and range of motion. RESULTS: Ninety-six (93%) of 103 fractures healed without bone grafting. All fractures eventually healed with secondary procedures, including bone grafting (1 of 68 closed fractures and 6 of 35 open fractures). There were 5 losses of proximal fixation, 2 nonunions, and 3 acute infections. No cases of varus collapse or screw loosening in the distal femoral fragment were observed. Malreductions of the femoral fracture were seen in 6 fractures (6%). The mean range of knee motion was 1 degrees to 109 degrees . CONCLUSIONS: Treatment of distal femur fractures with the LISS is associated with high union rates without autogenous bone grafting (93%), a low incidence of infection (3%), and maintenance of distal femoral fixation (100%). No loss of fixation in the distal femoral condyles was observed despite the treatment of 30 patients older than 65 years. The LISS is an acceptable surgical option for treatment of distal femoral fractures.