微创内固定系统治疗胫骨近端骨折疗效分析

目的探讨微创内固定系统(LISS)治疗胫骨近端骨折的疗效。方法对45例胫骨近端骨折行LISS治疗,记录手术时间、术中透视次数、术中出血量、术中输血量、术后下肢力线畸形程度、骨折愈合时间、HSS评分及并发症发生率。结果手术时间为45~91(68±10.5)min;术中透视次数为18~44(27±6)次;术中出血量为50~210(130±29)ml;术中输血量为0~300(56±13)ml。术后下肢力线畸形程度:内外翻畸形0°~5°(1°±0.3°),旋转畸形0°~7°(2°±0.7°),肢体长度误差0~0.8(0.3±0.1)cm。6例失访,39例获得随访,时间6~24(11±3.2)个月。骨折愈合时间2.5~6.5(3.8±1.5)个月。HSS评分:优20例,良15例,中4例,优良率89.7%。术后总体并发症发生率为15.4%(6例),其中浅表感染1例,内固定激惹2例,复位丢失出现内翻畸形(5°)2例,内旋畸形(7°)1例。结论 LISS是治疗胫骨近端骨折(特别是严重粉碎性骨折)安全、简单、有效的方法。

Analysis of clinical effect of less invasive stabilization system in the treatment of proximal tibi-al fracture

Objective To assess the clinical effect of less invasive stabilization system（LISS） in the treatment of proximal tibial fracture. Methods 45 patients with proximal tibial fracture were treated with LISS. Operation time, times of fluoroscopic examination by C-arm, amount of operation bleeding, amount of blood transfusion, malalignment degree of lower limb, time of bone union, score of hospital of special surgery,and rate of postoperative complications were recorded. Results The average operation time was 45 ～ 91 （68 ± 10. 5） rain, and the average times of fluoro scopic examination by C arm were 18 ～ 44 （27 ± 6）. The average amount of bleeding in operation was 50 ～ 210 （130 ± 29） ml, and the amount of blood transfusion was 0～ 300 （56 ± 13） ml. Valgus or varus of lower limb was 0～ 5 （1 ± 0. 3） degree postoperation, meanwhile the rotation of malalignment was 0 ～ 7 （2 ± 0.7） degree. Leg unequal length was limited at 0 ～ 0. 8 （0.3 ± 0. 1 ） cm. 6 patients lost to follow-up. 39 cases were completed effective follow up at last. The mean follow up time was 6 ～ 24 （ 11 ± 3.2 ） months. The time of bone union was 2. 5 ～ 6.5 （3.8 ± 1.5） months. Relative to the score of hospital of special surgery, the results showed excellent in 20 cases, good in 15 cases, and fair in 4 cases. The excellent and good rate was 89.7%. The rate of postoperative complications was 6/39 （15.4%）. The complications include superficial infection （1 case） , irritation by implant （2 cases） , varus deformi-ty followed loss of reduction （2 cases） and internal rotation deformity （1 case）. Conclusions LISS have many ad vantages, such as minimally invasive, convenient, simple, safe, and effective. LISS is a good choice for proximal tibial fracture, especially suitable for serious and comminuted fracture.