微创固定系统治疗股骨远端骨折53例

目的 探讨微创固定系统(less invasive stabilization system,LISS)在股骨远端骨折手术中的技术要点. 方法2003年7月-2007年2月,采用LISS治疗53例股骨远端骨折.骨折按AO分型:33A1型2例,33A2型11例,33A3型10例,33C1型3例,33C2型15例,33C3型12例.手术方法:对股骨髁间的关节内骨折切开复位,而股骨干骺端骨折则闭合复位,再通过小切口插入LISS钢板,骨折复位满意、钢板位置适宜后,瞄准臂引导下分别在远、近骨折段钻入4～6枚锁定螺钉. 结果 51例患者随访平均25.9个月,术后平均14.2周X线片示骨痂明显形成.无内固定松动、断裂及深部感染.患膝平均活动度为伸直1°、屈曲115°.美同特种外科医院(HSS)膝关节评分平均为87.6分,优33例,良17例,中1例. 结论股骨远端骨折LISS微创手术应注意:用较长的LISS钢板;钢板应与股骨外髁贴附好;经近端小切口触摸确认钢板近段在股骨外侧中央;钻入股骨干螺钉前应摄X线片检查;骨质疏松、粉碎骨折患者应结合双皮质锁定螺钉固定.

Treatment of distal femur fractures with less invasive stabilization system

Objective To explore the operative techniques in treatment of distal femur fractures with less invasive stabilization system (LISS). Methods From July 2003 to February 2007, 53 patients with fresh distal femur fractures were treated with LISS. There were 37 males and 16 females, an average age of 45.8 years (ranged from 19 to 82 years). There were two patients with type 33A1 fractures, 11 with type 33A2 fractures, 10 with type 33A3 fractures, three with type 33C1 fractures, 15 with type 33C2 fractures and 12 with type 33C3 fractures according to AO classification. After the articular segments of the fracture were treated with open reduction and fixation, fractures in the metaphyseal area were reduced indirectly. Then, the LISS plate was inserted through a small incision of the knee between the lateral vastus muscle and the periosteum. About 4-6 screws were inserted through stab incisions and locked into the plate holes. Results All patients were followed up for average 25.9 months. The X-ray showed fracture healing at mean 14.2 weeks ( ranged from 8 to 16 weeks) after operation, without fixation failure, implant breakage or deep infection. The mean range of motion ( ROM ) of the knee was 1°- 15°. According to the modified Hospital for Special Surgery (HSS) knee score, 33 patients were rated as excellent, 17 good and i fair, with HSS score of 67-99 (average 87.6). Conclusions The application of long plates fixed with individual screws is advantageous. The plate should be internally rotated by 10° to match the slope of the lateral femoral condyle. Palpation through a small incision over the proximal end of the plate is helpful to confirm the correct placement of the plate on the exact lateral aspect of the femur. Lateral and anteropesterior radiographs of the affected femur should be done before insertion of screws into femoral shaft. As for osteoporotic or comminuted fractures, bicortical locking screws should be used in the shaft area.