LISS钢板治疗胫骨多段骨折

胫骨多段骨折若处理不当会造成骨折不愈、皮肤软组织坏死骨外露,严重影响疗效。2009年1月～2010年10月,我科对22例胫骨多段骨折患者均选用胫骨前外侧LISS钢板内固定治疗,效果满意。1材料与方法1.1病例资料本组22例,男19例,女3例,年龄17～65岁。闭合性骨折14例,开放性骨折8例（GustiloⅠ型6例,Ⅱ型2例）,合并腓骨骨折20例。     

LISS钢板治疗老年骨质疏松的下肢骨折

AO微创内固定系统（Less invasive stabilization sysem，LISS）在本院用于治疗股骨远端骨折和胫骨近端骨折，取得较满意的效果。2004年8月至2007年8月应用Ao—Liss钢板治疗治疗老年骨质疏松股骨远侧骨折或胫骨近侧骨折13例，参考相关文献结合临床体会，对Liss手术治疗下肢骨质疏松性骨折的技术优势、适应征进行讨论。     

LISS钢板固定Schatzker Ⅵ型胫骨平台骨折疗效分析

目的探讨LISS钢板治疗SchatzkerⅥ型胫骨平台的疗效及操作技巧。方法对58例SchatzkerⅥ型胫骨平台骨折患者采用LISS钢板进行固定。记录并分析术后膝关节功能恢复情况、术后并发症情况。结果患者均获随访,时间15～27个月,骨折临床愈合时间为10～17周,87.9%的患者(51/58)在术后4周内膝关节活动范围恢复达120°。术后1年膝关节功能评定参照膝关节外科临床评分系统,优良率达到93.1%(54/58),疗效良好。1例发生远端锁定螺钉位于骨皮质外;1例出现外侧平台后部骨折块再移位;1例出现切口延迟愈合。无感染及骨折不愈合。结论采用LISS钢板固定SchatzkerⅥ型胫骨平台骨折,是一种有效的微创方法。正确安放钢板位置和恢复关节面平整是获得良好疗效的关键。     

股骨LISS钢板外固定治疗胫骨近侧干骺端骨折

目的探讨股骨LISS钢板外固定技术应用于胫骨近侧干骺端骨折的治疗效果。方法自2011-07—2012-09诊治45例胫骨近侧干骺端骨折,闭合性骨折33例,开放性骨折12例。采用股骨LISS钢板进行外固定,将钢板放置于胫骨前内侧面。观察手术时间、骨折愈合时间、邻近关节功能、术后并发症等情况,评价手术疗效。结果本组手术时间平均42(30~60)min。45例均获得平均15.6(12~19)个月随访,无切口感染、深部感染、骨折不愈合、钢板螺钉松动断裂发生。骨折临床愈合时间10~20周,平均13.8周。3例分别在术后3周、2个月、4个月时出现局部1或2枚外固定螺钉钉道持续渗出,2例接受每天3次、为期1周的酒精清洗后渗液消失,另1例经过1周酒精清洗后仍有渗液,拆除局部螺钉后钉道愈合。术后1年膝关节功能HSS评分:优38例,良4例,可3例,优良率93.3%;踝关节功能AOFAS评分:优39例,良4例,可2例,优良率95.6%。结论胫骨近侧干骺端骨折应用股骨LISS钢板外固定治疗能获得良好的效果,该手术具有操作简便、创伤小、钢板拆除简便等优点。     

LISS钢板内固定治疗下肢长骨严重粉碎骨折

[目的] 探讨微创内固定系统(less invasive stabilization system,LISS)内固定治疗股骨远端及胫骨近端粉碎性骨折的临床疗效.[方法] 2005年3月-2007年9月采用LISS治疗股骨远端及胫骨近端骨折32例,其中股骨13例,胫骨19例,观察术后骨折愈合情况、并发症及膝关节功能.[结果] 32例平均随访时间16.8个月,骨折全部愈合,平均时间7.8个月.术后骨折对位良好,内固定无松动、失效等并发症,膝关节功能无障碍.[结论] LISS接骨板治疗股骨远端及胫骨近端粉碎性骨折具有创伤小、固定可靠、骨折愈合时间短、并发症少、膝关节功能恢复好等优点.     

LISS钢板在治疗膝周复杂骨折中的应用体会

目的探讨IASS钢板在治疗膝周复杂骨折的方法和临床治疗效果。方法35例膝周复杂骨折患者均采用1ASS钢板治疗,其中男21例,女14例;年龄21-68岁,平均年龄46岁。致伤原因：交通伤23例,建筑伤10例,坠跌伤2例。股骨远端粉碎性骨折10例,胫骨平台骨折16例,胫骨近端粉碎性骨折9例。结果本组35例伤口全部一期愈合,全部病例随访3-19个月,平均11个月;手术时间45-190min,平均90min;术中无输血,出血100-400mL。结论LISS钢板具有创伤小、并发症小、骨愈合率高等优点,是治疗膝周复杂骨折的有效方法。     

LISS钢板治疗股骨远端骨折

目的:探讨LISS钢板在治疗股骨远端骨折的方法和临床治疗效果.方法:18例股骨远端骨折患者均采用LISS钢板治疗.结果:本姐18例伤口全部一期愈合,全部病例随访6～16个月,平均10个月.结论:LISS钢板具有创伤小、并发症小、骨愈合率高等优点,是治疗股骨远端骨折的有效方法.     

LISS钢板和解剖钢板治疗复杂胫骨平台骨折的Meta分析

[目的]比较LISS钢板与解剖钢板两种内固定治疗复杂胫骨平台骨折的安全性和有效性。[方法]计算机检索Pub Med、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较LISS钢板和解剖钢板治疗复杂胫骨平台骨折的临床对照试验,检索时限均为建库至2014年12月31日。同时手检纳入文献的参考文献。按纳入排除标准由2人独立进行筛选、资料提取和质量评价后,采用Rev Man 5.3软件进行Meta分析。[结果]共纳入11个研究,924例患者。Meta分析结果显示:(1)在安全性方面:与解剖钢板相比,LISS钢板手术时间较短[SMD=-0.40,95%CI(-0.63,-0.17),P0.05]、术中出血量较少[SMD=-0.66,95%CI(-1.16,-0.16),P0.05]、住院时间更短[SMD=-0.20,95%CI(-0.34,-0.07),P0.05]、总的并发症更少[RR=0.32,95%CI(0.14,0.70),P0.05]、骨折愈合时间无统计学意义[SMD=-0.08,95%CI(-0.21,0.05),P0.05]、术后开始负重时间无统计学意义[SMD=-0.06,95%CI(-0.26,0.13),P0.05];(2)在有效性方面:患者膝关节功能HSS评分差异无统计学意义[RR=0.79,95%CI(0.49,1.28),P0.05]。[结论]在复杂胫骨平台骨折中LISS钢板与解剖钢板相比,有效性基本相似,但LISS钢板手术时间更短、术中出血量较少、住院时间更短、总的并发症更少,安全性更高;但因原始研究的样本量较少,建议临床上根据患者的实际情况审慎选择使用;还需要更多高质量、大样本的RCT进一步论证。     

LISS与解剖钢板内固定治疗胫骨平台骨折的疗效比较

目的比较USS与解剖钢板内固定治疗胫骨平台骨折的疗效。方法回顾性分析自2009—06—2012—06治疗的46例资料较完整的胫骨平台骨折,按照手术方式的不同分为USS组（19例）和解剖钢板组（27例）。观察2组切口长度、手术时间、术中出血量、住院时间、术后至开始负重时间、骨折愈合时间、术后并发症及膝关节功能Rasmussen评分。结果USS组在切口长度、手术时间、术中出血量及术后并发症方面,优于解剖钢板组,差异有统计学意义（P〈0．05）,但2组住院时间、术后至开始负重时间和骨折愈合时间差异无统计学意义（P〉0．05）。膝关节功能Rasmussen评分：USS组优良率84．2％,解剖钢板组优良率77．8％,2组差异无统计学意义（P〉0．05）。结论USS与解剖钢板内固定治疗胫骨平台骨折疗效相当,但采用USS技术后术中组织损伤小,手术时间短,更有利于患者功能恢复。     

微创LISS钢板治疗胫腓骨骨折疗效观察

目的分析AO微创内固定系统(LISS)治疗胫腓骨骨折疗效。方法手术治疗92例胫腓骨骨折患者,LISS钢板组47例,解剖钢板组45例,观察两组骨折复位、膝关节功能恢复情况。结果患者均获随访,时间6~24个月。两组骨折愈合时间、内翻角比较差异无统计学意义(P0.05);LISS钢板组后倾角、膝关节自由活动度分别为10.7°±2.9°、128.3°±18.5°,均大于解剖钢板组的8.3°±1.7°、102.4°±17.6°(P0.01);LISS钢板组膝关节功能评分为(98.4±20.3)分,高于解剖钢板组的(80.3±18.9)分(P0.01);LISS钢板组并发症发生率为4.26%,低于解剖钢板组的20.00%(P0.05)。结论 LISS钢板治疗胫腓骨骨折安全可靠,膝关节恢复良好。     

The treatment of distal femoral fractures in children using the LISS plate: a report of two cases

We report two cases in which the technique of fracture fixation using the Less Invasive Stabilisation System (LISS) has been successfully used in the management of distal femoral fractures in the child.     

Reverse LISS plates for unstable proximal femoral fractures

The best treatment for unstable proximal femoral fractures is controversial. In this prospective study, we assessed the outcomes of reverse less invasive stabilisation system (LISS) plates for treatment of unstable proximal femoral fractures that are expected to be difficult to nail.From April 2004 to January 2007, 20 patients with unstable proximal femoral fractures that were assessed to be difficult to nail were managed with reverse less invasive stabilisation system-distal femur (LISS-DF) plates, which included (1) subtrochanteric fractures with extension into the piriform fossa, (2) short skeletons with narrow femoral canals, (3) adolescents with open physes and (4) severely bowed or deformed femurs. These patients were enrolled in this study. There were 11 females and nine males, with a median age of 58 years (range, 14-95 years).The average follow-up period was 24 (range, 12-32) months. Functional recovery (Parker and Palmer mobility score), pain, bony union, varus deformity, implant failure and leg length discrepancy were assessed. The fractures united at a median of 7 months (range, 3-15 months) postoperatively. Parker and Palmer mobility scores were 9 points for 17 patients and 6 points for three patients. Pain was absent in 15, mild in three, and moderate in two patients. Patients with poor quality of reduction were more likely to have pain results (p = 0.009). Although patients with advanced age were not more likely to have pain results, they were more likely to have ‘delayed union’ radiographic results (p = 0.033). Two limbs were shortened by 1.5 and 2 cm, respectively.Reverse LISS plate fixation led to complete union of unstable proximal femoral fractures without additional procedures. The surgical technique was simple and safe. We recommend considering the use of this locked-plate device as the alternative management of unstable proximal femoral fractures that are unsuitable for nailing procedures.     

LISS钢板治疗股骨远端C型骨折

目的 探讨LISS钢板固定治疗股骨远端C型骨折的临床疗效及手术要点.方法对22例股骨远端C型骨折患者采用LISS钢板固定,骨缺损者一期植骨.结果 22例均获随访,时间12~24个月,骨折均愈合.膝关节功能按Kolmert评分标准：优8例,良11例,可3例.结论 对股骨远端C型骨折采用LISS钢板固定,既能使骨折达到关节面解剖复位,又提供有效稳定的固定,是治疗股骨远端C型骨折的良好方法.     

Biomechanical assessment of single LISS versus double-plate osteosynthesis in the AO type 33-C2 fractures: A finite element analysis

ObjectivesIn the present study, we assessed the biomechanical advantage between the single LISS and double-plate used in AO type 33-C2 fractures with the method of finite element analysis, which will help surgeons choose the optimal therapy to the unstable distal femoral fracture.MethodsThe AO type 33-C2 fractures and the models of LISS plate and medial plate was constructed in 3-matic software and UG-NX software respectively. We then assembled the single plate and the double-plate to the fracture model separately to form the fixation models. After meshing the models’ elements, we used the Abaqus software to perform the finite element analysis. Values of peak Von Mises Stress (VMS) on the plate, maximum deformation of the models and the distance changes of the fracture gap were used to capture the mechanical factors in this study.ResultsOur results indicated that the single LISS underwent 1.2 times higher amount of stress than the double-plate (316.0 MPa VS 281.6 MPa). And the medial plate dispersed some stresses (the maximum stress is 47.4 MPa). Single-plate generated 3 times greater bending angle than double-plate (0.6° VS 0.2°). The bending angles of the single and double-fixation-fracture models are 0.9° and 0.3° respectively. The maximum distance changes of the fracture gap in the single-plate model was 2 times higher than that of double-plate model (2.6 mm VS 1.3 mm). In the torsional load analysis, peak VMS of the single and double model was 1.0 MPa and 0.8 MPa respectively. And the bending angle was 0.8° in the single model and 0.4° in the double model.ConclusionsThe double-plate is more effective scenario using in the distal femoral fractures, particular in unstable fractures with joint involvement.     

LISS钢板与解剖钢板治疗胫骨近端复杂性骨折的对比研究

目的探析胫骨近端复杂性骨折应用解剖钢板及LISS钢板治疗的IJ缶床效果。方法人选我院胫骨近端复杂性骨折患者66例,按治疗方法的不同分为治疗组、对照组,各33例,治疗组实施LISS钢板疗法,对照组实施常规解剖钢板内固定疗法,比较两组的手术参数、临床效果及并发症情况。结果治疗组的手术参数显著优于对照组（P〈0．05）;两组患者临床疗效比较,差异有统计学意义;治疗组的并发症发生率低于对照组（P〈0．05）。结论与解剖钢板相比,LISS钢板内固定治疗胫骨近端复杂性骨折具有创伤小、骨折愈合快、负重早及并发症少的优点,但两者的疗效相当。     

微创经皮LCP或LISS内固定治疗膝关节周围骨折

目的总结微创经皮LCP或LISS内固定治疗膝关节周围骨折的疗效。方法41例采用微创经皮LCP或LISS内固定治疗膝关节周围骨折,对其临床疗效进行分析。结果41例患者经6～30个月随访,平均17.6个月,除骨延迟愈合1例、内固定取出困难2例外,无其他并发症。参照Johner-Wruh方法进行疗效评价,优24例、良13例、中3例、差1例,总优良率为90.24%。结论微创经皮LCP或LISS内固定治疗膝关节周围骨折疗效满意,进一步熟悉局部解剖学特点和掌握手术技巧有助于提高疗效。     

The role of LISS (less invasive stabilisation system) in the treatment of peri-knee fractures

The purpose of present study was to evaluate the role of LISS after a large series of patients in whom a fracture around the knee had been treated with this uniform technique. Between April 2004 and September 2006, 210 patients with a total of 216 fractures around the knee were treated with LISS, all at the Affiliated Hospital to Nantong University. Patients were followed for a mean of 27 months (range 12–42 months). 26 patients were excluded from the study. The remaining 184 patients with a total of 189 fractures of either distal femur (85 cases) or proximal tibia (104 cases) were available for analysis. The mean age of these patients was 49 years (range 18–82 years). Immediate postoperative X-rays showed the alignment of bone and joint was satisfactorily maintained with LISS in all cases and an ideal implant position in 176 cases (93%). All cases healed the fracture without non-union. The mean time to union was 15 weeks (range 12–27 weeks) for the femoral and 16 weeks (range 12–27 weeks) for the tibia fractures. Functional assessment was performed using HSS (hospital for special surgery) score. At the time of the latest follow-up, 158 patients (86%) had an excellent or good outcome. Overall, 3 patients were subject to a salvage operative procedure due to implant failure. Three cases underwent secondary bone graft for open fractures. Superficial and deep infection was found each in one patient and both were treated successfully. Hardware prominence irritation was found in 2 patients. LISS was removed in 27 patients after bone healing, and this procedure was neither less invasive nor easy as imagined. The results indicate the LISS system is perfect but by no means unique in the treatment of the fractures around the knee. The fixation is adequate enough to maintain alignment and obtain union with a low incidence of complications even in patients with osteoporotic bone. We firmly believe favourable results can be achieved when this device is combined with correct indications as well as skillful techniques.     

The clinical and radiological outcomes of the LISS plate for distal femoral fractures: A systematic review

Purpose

The purpose of this systematic review was to assess the literature evaluating the clinical and radiological outcomes following less invasive surgical stabilisation system (LISS) fixation of distal femoral fractures (AO 32/33).

Methods

A review of EMBASE, Medline, CINAHL and AMED from their inception to November 2008, sources of grey literature and a pertinent hand search of specialist orthopaedic journals was undertaken.

Results

Twenty-one studies assessing 663 patients with 694 fractures were reviewed. The findings suggest that the LISS system may be an appropriate fixation method for the management of distal femoral fractures. However, there remains a high incidence of loss of reduction (n = 134; 19%), delayed or non-union (n = 40; 6%) and implant failure (n = 38; 5%). On analysis, such complications were largely confined to articles published before 2005, therefore during the infancy of the widespread clinical application of this trauma system. On critical appraisal, the evidence-base remains limited by recruiting small, under-powered sample sizes and poorly accounting for confounding variables such as osteoporosis, diabetes, multi-trauma and fracture classification.

Conclusion

Further study is required to assess the outcomes of LISS fixation in specific patient populations, and to compare the outcome of this fixation method to condylar plates and intrameduallary devices, to determine the optimal management strategy for this complex patient group.