闭合复位LISS钢板治疗胫骨近端多段骨折的临床疗效

目的：通过应用闭合复位AO微创内固定系统（LISS）治疗胫骨近端多段骨折，探讨闭合复位LISS固定对该类骨折复位及愈合的影响。方法：2003年7月至2007年12月，采用闭合复位LISS钢板治疗胫骨近端多段骨折19例，男14例，女5例；年龄21—49岁，平均39．2岁；直接暴力致伤15例，间接暴力致伤4例。致伤原因：交通伤14例，高处坠落伤3例，摔伤2例。于术后随访观察患肢功能恢复情况，及摄X线片显示骨痂生成和骨折愈合情况。结果：患者均获随访，时间8-21个月，平均12．2个月。无固定丢失和骨折不愈合，无钢板和螺钉变形，无软组织感染。膝关节功能按Merchan等评分标准评定，优14例，良3例，可2例。结论：采用闭合复位LISS钢板治疗胫骨近端多段骨折，是一种有效的内固定方法，具有稳定固定、愈合率高、创伤低等优点。

Treatment of proximal tibial multi-segment comminuted fractures with closed reduction and less invasive stabilization systems

Objective: To explore the clinical effects of closed reduction and less invasive stablization system for the treatment of proximal tibial multi-segment comminuted fractures,and to discuss the influence of LISS on reduction and bone union. Methods: From 2003.7 to 2007.12,19 patients with proximal tibial multi-segment comminuted fractures were treated with closed reduction and LISS fixation. Forteen patients were male,5 patients were female,ranging in age from 21 to 49 years,with an average of 39.2 years. Fifteen patients were injured with direct violence,4 indirect violence. The reasons of the injuries were vehicle crashes for 14 cases and falling from high places for 3 cases and falling to the ground for 2 cases. All the patients were followed up postoperatively. Callus formation and bony union were recorded by X-ray. Results: All the patients were followed up for a period averaged 12.2 months(ranged 8 to 21 months). No failure of fixation and nonunion. No deformation of plates and screws occurred in patients,no superficial wound infection. According to the criteria of Merchan,14 patients got an excellent result,3 good,and 2 poor. Conclusion: Closed reduction and less invasive stabilization systems can provide rigid internal fixation for proximal tibial multi-segment comminuted fractures. The LISS provides stable fixation,a high rate of union,and a low rate of infection for proximal tibial multi-segment comminuted fractures.